Organization
CLEAR LAKE NEURO DIAGNOSTIC CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLA MARIE LEBAS M.D. (OFFICER)
(281) 332-6949
Entity
Organization
Contact information
Practice address
380 E MEDICAL CENTER BLVD, WEBSTER, TX 77598-4321
(281) 332-6949
(281) 332-6965
Mailing address
380 E MEDICAL CENTER BLVD, WEBSTER, TX 77598-4321
(281) 332-6949
(281) 332-6965
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J9590
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE5776
MEDICARE, RAILROAD
TX
Enumeration date
02/06/2007
Last updated
03/04/2011
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