Provider Demographics
NPI:1538158563
Name:GASTROENTEROLOGY DIAGNOSTIC CLINIC,
Entity type:Organization
Organization Name:GASTROENTEROLOGY DIAGNOSTIC CLINIC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-998-2488
Mailing Address - Street 1:5050 CRENSHAW RD
Mailing Address - Street 2:#200
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3139
Mailing Address - Country:US
Mailing Address - Phone:281-998-2488
Mailing Address - Fax:281-998-2482
Practice Address - Street 1:5050 CRENSHAW RD
Practice Address - Street 2:#200
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3139
Practice Address - Country:US
Practice Address - Phone:281-998-2488
Practice Address - Fax:281-998-2482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094050401Medicaid
TX00U25BMedicare PIN