=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164645271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEXOMA GASTROENTEROLOGY CONSULTANTS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2007
-----------------------------------------------------
Last Update Date | 11/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 N HIGHLAND AVE SUITE 130
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75092-7377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-892-9179
-----------------------------------------------------
Fax | 903-868-2317
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 N HIGHLAND # 130
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75092-7383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-892-9179
-----------------------------------------------------
Fax | 903-868-2317
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN THOMAS FLETCHER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 903-892-9179
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------