Organization
DOC ON THE BAY ASSOCIATED ENTERPRISES INCORPORATED
Active
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
Update your record
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