Healthcare Provider Details

I. General information

NPI: 1295314557
Provider Name (Legal Business Name): ANDY HUANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 JOE RAMSEY BLVD E
GREENVILLE TX
75401-7852
US

IV. Provider business mailing address

4215 JOE RAMSEY BLVD E
GREENVILLE TX
75401-7852
US

V. Phone/Fax

Practice location:
  • Phone: 903-408-5000
  • Fax:
Mailing address:
  • Phone: 903-408-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU3883
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: