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General NPI Number Information
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NPI Number | 1174891105
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Entity Type | Organization
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Legal Business Name | NACOGDOCHES SPINE PLLC
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 625 RUSSELL BLVD
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1247
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Country | US
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Telephone | 936-560-1190
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Fax | 936-560-1823
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Provider Business Mailing Address
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Address Line | 625 RUSSELL BLVD
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1247
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Country | US
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Telephone | 936-560-1190
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Fax | 936-560-1823
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Authorized Official
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Title or Position | OWNER
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Name | DR. NEAL GREGORY HAYNES
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Credential | MD
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Telephone | 936-560-1190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | N2561
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License Number State | TX
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