Provider Demographics
NPI:1063530038
Name:WOODLANDS NEUROLOGY AND SLEEP PA
Entity type:Organization
Organization Name:WOODLANDS NEUROLOGY AND SLEEP PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAFFNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-465-4050
Mailing Address - Street 1:9303 PINECROFT DR
Mailing Address - Street 2:STE 270
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3181
Mailing Address - Country:US
Mailing Address - Phone:281-465-4050
Mailing Address - Fax:281-465-4105
Practice Address - Street 1:9303 PINECROFT DR
Practice Address - Street 2:STE 270
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3181
Practice Address - Country:US
Practice Address - Phone:281-465-4050
Practice Address - Fax:281-465-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157195201Medicaid
TX0063JVOtherBCBS
TX157195201Medicaid