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General NPI Number Information
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NPI Number | 1194044792
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Entity Type | Organization
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Legal Business Name | PROMONTORY GERIATRICS LLC
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 2727 BOLTON BOONE DR STE 114
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City | DESOTO
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State | TX
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Zip | 75115-2019
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Country | US
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Telephone | 469-857-3142
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Fax | 469-857-3077
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Provider Business Mailing Address
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Address Line | 2727 BOLTON BOONE DR STE 114
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City | DESOTO
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State | TX
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Zip | 75115-2019
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Country | US
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Telephone | 469-857-3142
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Fax | 469-857-3077
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Authorized Official
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Title or Position | MANAGING OFFICER
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Name | GENE O BIGHAM
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Credential |
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Telephone | 469-857-3142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J6337
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number |
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License Number State | NULL
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