Organization
DOC ON THE BAY ASSOCIATED ENTERPRISES INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURIE KILLAM OTRL (OFFICE MANAGER)
(281) 452-3547
Entity
Organization
Contact information
Practice address
15055 EAST FWY STE C10, CHANNELVIEW, TX 77530-4142
(281) 452-3547
Mailing address
15055 EAST FWY STE C10, CHANNELVIEW, TX 77530-4142
(281) 452-3547
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
H5715
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00630V
BLUE CROSS BLUE SHIELD
TX
05
—
111525501
—
TX
05
—
111525504
—
TX
05
—
11525501
—
TX
05
—
193614801
—
TX
Enumeration date
03/05/2007
Last updated
10/31/2008
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