Provider Demographics
NPI:1689960361
Name:NEUROLOGY DIAGNOSTIC CENTERS OF TEXAS, PA
Entity Type:Organization
Organization Name:NEUROLOGY DIAGNOSTIC CENTERS OF TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEURODIAGNOTIC SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-835-2607
Mailing Address - Street 1:5959 WEST LOOP S
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2421
Mailing Address - Country:US
Mailing Address - Phone:713-481-1016
Mailing Address - Fax:713-481-4608
Practice Address - Street 1:5959 WEST LOOP S
Practice Address - Street 2:SUITE 302
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2421
Practice Address - Country:US
Practice Address - Phone:713-481-1016
Practice Address - Fax:713-481-4608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty