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General NPI Number Information
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NPI Number | 1245248608
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Entity Type | Individual
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Provider Name | RAYMOND J MAILLOUX MD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 09/19/2010
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Provider Practice Location Address
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Address Line | 1000 S FM 1417
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City | SHERMAN
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State | TX
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Zip | 75092-4865
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Country | US
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Telephone | 903-892-2133
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Fax | 903-893-6317
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Provider Business Mailing Address
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Address Line | 6006 FIRECREST DR
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City | GARLAND
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State | TX
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Zip | 75044-4208
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Country | US
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Telephone | 903-814-5955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E9787
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License Number State | TX
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