Provider Demographics
NPI:1023047941
Name:DIAGNOSTIC IMAGINING SPECIALIST
Entity type:Organization
Organization Name:DIAGNOSTIC IMAGINING SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-618-9046
Mailing Address - Street 1:2323 E. HWY 35
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515
Mailing Address - Country:US
Mailing Address - Phone:979-849-2738
Mailing Address - Fax:979-849-3625
Practice Address - Street 1:2323 E. HWY 35
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3804
Practice Address - Country:US
Practice Address - Phone:979-849-2738
Practice Address - Fax:979-849-3625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0074AKOtherBCBS
TX081089701Medicaid
TX081089701Medicaid