Organization
EASTLAKE SURGICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY BROOKE MORELAND LSA (LICENSED SURGICAL ASSISTANT)
(936) 444-7071
Entity
Organization
Contact information
Practice address
2007 SHASTA RIDGE DR, CONROE, TX 77304-4697
(936) 444-7071
Mailing address
2007 SHASTA RIDGE DR, CONROE, TX 77304-4697
(936) 444-7071
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA00639
TX
Other
Enumeration date
08/14/2018
Last updated
03/30/2022
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