Eastlake Surgical Associates, LLC
Physician Assistant, Surgical in Conroe, TX. Organization (NPI-2).
NPI number1780163378
StatusActive
Last updated in NPPESMar 30, 2022
Details
- NPI
- 1780163378
- Entity type
- Organization (NPI-2)
- Legal business name
- Eastlake Surgical Associates, LLC
- Organization subpart
- No
- Enumeration date
- Aug 14, 2018
- Certification date
- Jul 30, 2020
- Last updated
- Mar 30, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AS0400X | Physician Assistant, Surgical | SA00639 | TX | Yes |
Practice location
2007 Shasta Ridge DrConroe, TX 77304-4697
Phone 936-444-7071
Mailing address
2007 Shasta Ridge DrConroe, TX 77304-4697
Phone 936-444-7071
Authorized official
Tiffany Brooke Moreland
Licensed Surgical Assistant
9364447071
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