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508 This Way St Lake Jackson TX 77566-5128 | |
| (979) 480-9467 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 508 This Way St, Lake Jackson, Texas |
| Authorized Official Name and Position | Daniel Buche (CHEIF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9792851105 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
100 Medical Dr Lake Jackson TX 77566-5674 Ph: (979) 285-1105 | 508 This Way St Lake Jackson TX 77566-5128 Ph: (979) 480-9467 |
| NPI Number | 1861795197 |
|---|---|
| Provider Enumeration Date | 12/08/2010 |
| Last Update Date | 01/03/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861795197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (Texas) | Secondary |
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