Provider Demographics
NPI:1356979397
Name:LUBBOCK GASTROENTEROLOGY & LIVER ASSOCIATES PLLC
Entity type:Organization
Organization Name:LUBBOCK GASTROENTEROLOGY & LIVER ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFIUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-696-4440
Mailing Address - Street 1:4505 82ND ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3219
Mailing Address - Country:US
Mailing Address - Phone:806-696-4440
Mailing Address - Fax:806-696-4441
Practice Address - Street 1:4505 82ND ST STE 5
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3219
Practice Address - Country:US
Practice Address - Phone:806-696-4440
Practice Address - Fax:806-696-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty