National Provider Identifier Database

LONGEVITY MEDICINE PLLC
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.


Contact Information

LONGEVITY MEDICINE, PLLC
120 RAILROAD STREET
BOLING-IAGO, TX77420
Phone: 979-657-4000
Fax:
Website:
Specialty Taxonomy Code
* General Practice 208D00000X

* Indicates primary specialty

NPI Profile & details for LONGEVITY MEDICINE, PLLC

NPI Number 1962672204
Legal business name
LBN
LONGEVITY MEDICINE, PLLC
Authorized official PETER ERICKSON - (PRESIDENT/CEO)
Entity Organization
Organization subpart No
Enumeration date 03/03/2008
Last updated 03/03/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • TX License #: E5746

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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