Provider Demographics
NPI:1346360963
Name:OCCUPATIONAL MEDICINE OF LA PORTE P.A.
Entity Type:Organization
Organization Name:OCCUPATIONAL MEDICINE OF LA PORTE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:ASHBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-842-1200
Mailing Address - Street 1:PO BOX 1518
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77572-1518
Mailing Address - Country:US
Mailing Address - Phone:281-842-1200
Mailing Address - Fax:281-842-1203
Practice Address - Street 1:410 E FAIRMONT PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6498
Practice Address - Country:US
Practice Address - Phone:281-842-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH 4864207QA0505X
TXH48642083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty