OrganizationActive
Longevity Medicine, PLLC
NPI 1962672204 · General Practice Physician · Boling, TX
Provider details
- NPI number
- 1962672204
- Entity type
- Organization
- Primary specialty
- General Practice PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Peter Erickson, President/Ceo(979) 657-4400
- License
- E5746 (TX)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(87/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
120 Railroad Street
Boling, TX 77420
Phone: (979) 657-4000
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 700
Boling, TX 77420-0700
Registry dates
- Enumerated
- 2008-03-03
- Last updated
- 2008-03-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.