Longevity Medicine, Pllc

NPI #1962672204 in Boling, Texas

Provider Information

NPI Number: 1962672204
Entity Type: Organization
Organization Name: Longevity Medicine, Pllc
Primary Specialty: General Practice
Enumeration Date: Mar 3, 2008
Last Updated: Mar 3, 2008

Practice Location

Address: 120 RAILROAD STREET
City: Boling
State: Texas
ZIP Code: 77420
Phone: (979) 657-4000

Authorized Official

Name: PETER ERICKSON, M.D.
Title: PRESIDENT/CEO
Phone: (979) 657-4400

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
General Practice	208D00000X	Primary

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