Provider Demographics
NPI:1437423324
Name:HOWARD L DILLARD JR MD PA
Entity Type:Organization
Organization Name:HOWARD L DILLARD JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:DILLARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:281-338-1881
Mailing Address - Street 1:6 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4127
Mailing Address - Country:US
Mailing Address - Phone:281-338-1881
Mailing Address - Fax:281-554-4888
Practice Address - Street 1:6 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4127
Practice Address - Country:US
Practice Address - Phone:281-338-1881
Practice Address - Fax:281-554-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000HC526Medicaid
TXP000HC526Medicaid
B22272Medicare UPIN