Healthcare Provider Details

I. General information

NPI: 1194086926
Provider Name (Legal Business Name): PHILLIP PACE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 RICHMOND RD
TEXARKANA TX
75503-0705
US

IV. Provider business mailing address

2900 SAINT MICHAEL DR STE 401
TEXARKANA TX
75503-5211
US

V. Phone/Fax

Practice location:
  • Phone: 903-614-5270
  • Fax: 903-614-5279
Mailing address:
  • Phone: 903-614-5367
  • Fax: 903-614-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9660
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-8551
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: