Healthcare Provider Details

I. General information

NPI: 1184953580
Provider Name (Legal Business Name): THOMAS HOWARD ALEXANDER JR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 OLYMPIC PLAZA CIR STE 906B
TYLER TX
75701-1958
US

IV. Provider business mailing address

PO BOX 6813
TYLER TX
75711-6813
US

V. Phone/Fax

Practice location:
  • Phone: 903-592-8685
  • Fax:
Mailing address:
  • Phone: 903-592-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS HOWARD ALEXANDER JR.
Title or Position: OWNER
Credential: R.V.T.
Phone: 903-592-8685