Organization
MDA DIVERSIFIED ENTERPRISES CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY BROWN (CREDENTIAL/BILLER)
(281) 556-1298
Entity
Organization
Contact information
Practice address
23527 FM 1314 RD STE E, PORTER, TX 77365-3724
(281) 381-6190
Mailing address
21013 OLD SORTERS RD STE E, PORTER, TX 77365-7083
(281) 381-6190
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/26/2021
Last updated
04/26/2021
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