# LONGEVITY MEDICINE, PLLC

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

## Provider details

- **NPI number:** 1962672204
- **Authorized official:** PETER ERICKSON M.D. (PRESIDENT/CEO)
- **Authorized official phone:** (979) 657-4400

## Contact information

- **Practice address:** 120 RAILROAD STREET, BOLING, TX 77420
- **Practice address phone:** (979) 657-4000
- **Mailing address:** PO BOX 700, BOLING, TX 77420-0700
- **Mailing address phone:** (979) 657-4400
- **Mailing address fax:** (979) 657-3800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | E5746 | TX | Yes |

## Other

- **Enumeration date:** 03/03/2008
- **Last updated:** 03/03/2008