Provider Demographics
NPI:1508280439
Name:D & H HEALTHCARE PROFESSIONALS LLC
Entity Type:Organization
Organization Name:D & H HEALTHCARE PROFESSIONALS LLC
Other - Org Name:CLEAR LAKE HEALTHCARE PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAIRWEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-831-9861
Mailing Address - Street 1:13920 OSPREY CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1615
Mailing Address - Country:US
Mailing Address - Phone:832-831-9861
Mailing Address - Fax:
Practice Address - Street 1:13920 OSPREY CT
Practice Address - Street 2:SUITE C
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1615
Practice Address - Country:US
Practice Address - Phone:832-831-9861
Practice Address - Fax:832-204-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7373261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center