Basic Information
| Provider Information | |||||||||
| NPI: | 1326047754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOWITZ | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | JACOB | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5420 DASHWOOD DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770815333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134862900 | ||||||||
| FaxNumber: | 7136641272 | ||||||||
| Practice Location | |||||||||
| Address1: | 5420 DASHWOOD DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770815333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134862900 | ||||||||
| FaxNumber: | 7136641272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 05/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | F0275 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8DQ534 | 01 | BCBS | OTHER | P01135314 | 01 | RAILROAD MEDICARE | OTHER | 118640506 | 05 | TX | MEDICAID |