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General NPI Number Information
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NPI Number | 1033343611
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Entity Type | Individual
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Provider Name | NATHAN DANIEL LILES MD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 800 E. DAWSON TRINITY MOTHER FRANCES HOSPITAL
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City | TYLER
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State | TX
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Zip | 75701
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Country | US
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Telephone | 512-814-0298
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Fax | 512-597-2713
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Provider Business Mailing Address
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Address Line | 800 E DAWSON PATHOLOGY
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City | TYLER
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State | TX
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Zip | 75701
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Country | US
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Telephone | 903-606-7494
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Fax | 903-606-2729
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | N2174
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License Number State | TX
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