Provider Demographics
NPI:1760007298
Name:HOUSTON LUNG CLINIC L.L.C.
Entity Type:Organization
Organization Name:HOUSTON LUNG CLINIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-333-2522
Mailing Address - Street 1:PO BOX 8537
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-8537
Mailing Address - Country:US
Mailing Address - Phone:478-923-2678
Mailing Address - Fax:478-929-4251
Practice Address - Street 1:92 TOMMY STALNAKER DR
Practice Address - Street 2:
Practice Address - City:W. R.
Practice Address - State:GA
Practice Address - Zip Code:31088-9179
Practice Address - Country:US
Practice Address - Phone:478-333-2522
Practice Address - Fax:478-333-3160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52467OtherMD LICENSE