Healthcare Provider Details

I. General information

NPI: 1184996225
Provider Name (Legal Business Name): EAST TEXAS PHYSICIAN'S ALLIANCE, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E OAK ST
PALESTINE TX
75801-2800
US

IV. Provider business mailing address

3201 S LOOP 256 SUITE 710
PALESTINE TX
75801-6901
US

V. Phone/Fax

Practice location:
  • Phone: 903-731-4555
  • Fax: 903-731-4699
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEC LAW
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 903-731-4555