Healthcare Provider Details

I. General information

NPI: 1194725820
Provider Name (Legal Business Name): JOHN MICHAEL STRAYHORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 COWHORN CREEK RD
TEXARKANA TX
75503-9766
US

IV. Provider business mailing address

5002 COWHORN CREEK RD
TEXARKANA TX
75503-9766
US

V. Phone/Fax

Practice location:
  • Phone: 903-614-3000
  • Fax: 903-614-3525
Mailing address:
  • Phone: 903-614-3000
  • Fax: 903-614-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH2815
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberH2815
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: