Provider Demographics
NPI:1457892028
Name:TEXAS DIGESTIVE DISEASE CONSULTANTS, PLLC
Entity type:Organization
Organization Name:TEXAS DIGESTIVE DISEASE CONSULTANTS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-572-0009
Mailing Address - Street 1:1620 W. NORTHWEST HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3119
Mailing Address - Country:US
Mailing Address - Phone:817-572-0009
Mailing Address - Fax:817-572-0221
Practice Address - Street 1:26103 I-45
Practice Address - Street 2:SUITE 200
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3876
Practice Address - Country:US
Practice Address - Phone:713-730-2947
Practice Address - Fax:713-730-2948
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TX DIGESTIVE DISEASE CONSULTANTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-16
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336S0011X
TX319413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177345OtherPK