Basic Information
| Provider Information | |||||||||
| NPI: | 1730299090 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGESTIVE AND LIVER DISEASES CLINIC PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 540088 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772540088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134010733 | ||||||||
| FaxNumber: | 7134010775 | ||||||||
| Practice Location | |||||||||
| Address1: | 17200 ST LUKES WAY | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773848007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9362662000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MEMON | ||||||||
| AuthorizedOfficialFirstName: | ILYAS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7134010733 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.