Provider Demographics
NPI:1346425469
Name:GULF COAST CENTER FOR NEUROLOGICAL DISORDERS, PA
Entity Type:Organization
Organization Name:GULF COAST CENTER FOR NEUROLOGICAL DISORDERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-796-5800
Mailing Address - Street 1:11 PINE LODGE PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2015
Mailing Address - Country:US
Mailing Address - Phone:281-796-5800
Mailing Address - Fax:281-419-3733
Practice Address - Street 1:11 PINE LODGE PL
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2015
Practice Address - Country:US
Practice Address - Phone:281-796-5800
Practice Address - Fax:281-419-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7626204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00918WMedicare PIN