Provider Demographics
NPI:1902820368
Name:ALLERGY & ENT ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:ALLERGY & ENT ASSOCIATES, PLLC
Other - Org Name:ALLERGY & ENT ASSOCIATES, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-453-4204
Mailing Address - Street 1:450 GEARS ROAD
Mailing Address - Street 2:SUITE 420B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-4509
Mailing Address - Country:US
Mailing Address - Phone:281-453-4204
Mailing Address - Fax:281-874-0212
Practice Address - Street 1:106 CIRCLE WAY
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:979-297-6503
Practice Address - Fax:979-297-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2021-12-22
Deactivation Date:2021-07-21
Deactivation Code:
Reactivation Date:2021-09-02
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB106895Medicare PIN