Healthcare Provider Details

I. General information

NPI: 1407199664
Provider Name (Legal Business Name): LONGVIEW PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 N 4TH ST STE B
LONGVIEW TX
75601-4768
US

IV. Provider business mailing address

1009 N 4TH ST STE B
LONGVIEW TX
75601-4768
US

V. Phone/Fax

Practice location:
  • Phone: 903-212-4330
  • Fax: 903-212-4333
Mailing address:
  • Phone: 903-212-4330
  • Fax: 903-212-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM6080
License Number StateTX

VIII. Authorized Official

Name: DR. ERIC CHEN
Title or Position: MD
Credential: MD
Phone: 903-212-4330