Basic Information
| Provider Information | |||||||||
| NPI: | 1407855893 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BELLAIRE FAMILY AND GENERAL PRACTICE ASSOCIATES, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5420 DASHWOOD DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770815357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136640719 | ||||||||
| FaxNumber: | 7136641272 | ||||||||
| Practice Location | |||||||||
| Address1: | 5420 DASHWOOD DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770815357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136640719 | ||||||||
| FaxNumber: | 7136641272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | GARB | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
| AuthorizedOfficialMiddleName: | JULIAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7136640719 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | LK08 | 01 | TX | BCBS OF TEXAS | OTHER | 153313501 | 05 | TX | MEDICAID | 130087 | 01 | TX | AETNA | OTHER | J7064 | 01 | TX | RAILROAD MEDICARE | OTHER |