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General NPI Number Information
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NPI Number | 1225637820
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Entity Type | Organization
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Legal Business Name | PHOTON IMAGING, PLLC
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 515 W 12TH ST
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City | TEXARKANA
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State | TX
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Zip | 75501-4416
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Country | US
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Telephone | 903-735-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 20148 FM 449
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City | LONGVIEW
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State | TX
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Zip | 75605-7731
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Country | US
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Telephone | 903-736-3179
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JOHN C CAMPBELL
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Credential | MD
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Telephone | 903-736-3179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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