# MDA DIVERSIFIED ENTERPRISES CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598347890
- **Authorized official:** BETTY BROWN (CREDENTIAL/BILLER)
- **Authorized official phone:** (281) 556-1298

## Contact information

- **Practice address:** 23527 FM 1314 RD STE E, PORTER, TX 77365-3724
- **Practice address phone:** (281) 381-6190
- **Mailing address:** 21013 OLD SORTERS RD STE E, PORTER, TX 77365-7083
- **Mailing address phone:** (281) 381-6190

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/26/2021
- **Last updated:** 04/26/2021