Organization
LONGEVITY MEDICINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER ERICKSON M.D. (PRESIDENT/CEO)
(979) 657-4400
Entity
Organization
Contact information
Practice address
120 RAILROAD STREET, BOLING, TX 77420
(979) 657-4000
Mailing address
PO BOX 700, BOLING, TX 77420-0700
(979) 657-4400
(979) 657-3800
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
E5746
TX
Other
Enumeration date
03/03/2008
Last updated
03/03/2008
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