Healthcare Provider Details

I. General information

NPI: 1235162777
Provider Name (Legal Business Name): EAST TEXAS MEDICAL SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E MARSHALL AVE
LONGVIEW TX
75601-5580
US

IV. Provider business mailing address

9229 LYNDON B JOHNSON FWY SUITE 250
DALLAS TX
75243-3405
US

V. Phone/Fax

Practice location:
  • Phone: 903-315-2000
  • Fax:
Mailing address:
  • Phone: 972-739-3097
  • Fax: 972-739-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STANLEY D. UPCHURCH
Title or Position: PARTNER
Credential: M.D.
Phone: 903-315-2445