Provider Demographics
NPI:1376754184
Name:DCOA PHYSICIAN ASSOCIATES PA
Entity Type:Organization
Organization Name:DCOA PHYSICIAN ASSOCIATES PA
Other - Org Name:DIABETES AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-237-3500
Mailing Address - Street 1:13100 NORTHWEST FREEWAY
Mailing Address - Street 2:STE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-6346
Mailing Address - Country:US
Mailing Address - Phone:832-237-3500
Mailing Address - Fax:281-897-9906
Practice Address - Street 1:10970 SHADOW CREEK PKWY
Practice Address - Street 2:SUITE 270
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-0100
Practice Address - Country:US
Practice Address - Phone:713-840-5210
Practice Address - Fax:713-436-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RE0101X
TX00593X261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty