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General NPI Number Information
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NPI Number | 1235387424
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Entity Type | Organization
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Legal Business Name | EAST TEXAS PHYSICIANS ALLIANCE,LLP
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 3201 S LOOP 256
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City | PALESTINE
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State | TX
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Zip | 75801-6901
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Country | US
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Telephone | 903-661-7173
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Fax | 903-661-7182
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Provider Business Mailing Address
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Address Line | PO BOX 4550
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City | PALESTINE
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State | TX
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Zip | 75802-4550
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Country | US
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Telephone | 903-731-4700
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Fax | 903-731-4699
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. ALEC B LAW
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Credential | MD
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Telephone | 903-723-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 662200000
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License Number State | TX
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