Provider Demographics
NPI:1376531905
Name:CENTER FOR GENERAL & LAPAROSCOPIC SURGERY PA
Entity Type:Organization
Organization Name:CENTER FOR GENERAL & LAPAROSCOPIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ESEROGHENE
Authorized Official - Middle Name:
Authorized Official - Last Name:OTAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-232-3886
Mailing Address - Street 1:138 ELDRIDGE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4083
Mailing Address - Country:US
Mailing Address - Phone:281-232-3886
Mailing Address - Fax:281-232-3986
Practice Address - Street 1:138 ELDRIDGE RD
Practice Address - Street 2:SUITE E
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4083
Practice Address - Country:US
Practice Address - Phone:281-232-3886
Practice Address - Fax:281-232-3986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6554208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1663841OtherSUFFIX 03 DR E OTAH
1703076OtherCTR FOR GEN AND LAP SURG
1703076OtherCTR FOR GEN AND LAP SURG
00424XMedicare ID - Type Unspecified