Provider Demographics
NPI:1508048836
Name:LEOPOLDO LAPUERTA JR, M.D., P.A.
Entity Type:Organization
Organization Name:LEOPOLDO LAPUERTA JR, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEOPOLDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPUERTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:713-655-1116
Mailing Address - Street 1:2360 COUNTY ROAD 94
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4884
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2360 COUNTY ROAD 94
Practice Address - Street 2:SUITE 104
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4884
Practice Address - Country:US
Practice Address - Phone:713-655-1116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6365208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00867XMedicare PIN