Organization
CHAMPIONS SPINE CENTER PA
Active
Other names
Lake Jackson Family Practice, PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAQIB A SIDDIQUI M.D. (MD/PRESIDENT)
(281) 292-1121
Entity
Organization
Contact information
Practice address
14450 TC JESTER BLVD. SUITE 100, HOUSTON, TX 77014
(281) 292-1121
Mailing address
14450 TC JESTER BLVD. SUITE 100, HOUSTON, TX 77014
(281) 292-1121
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
N3996
TX
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
M9431
TX
Other
Enumeration date
07/14/2009
Last updated
05/19/2011
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