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General NPI Number Information
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NPI Number | 1538520515
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Entity Type | Organization
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Legal Business Name | TWIN CITY UROLOGY ASSOCIATES, P.A.
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 704 W GROVE ST SUITE 4
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City | EL DORADO
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State | AR
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Zip | 71730-4416
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Country | US
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Telephone | 501-766-3430
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Fax |
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Provider Business Mailing Address
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Address Line | 704 WEST GROVE STREET SUITE 4
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City | EL DORADO
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State | AR
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Zip | 71730
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMUEL T HOUSTON
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Credential | M.D.
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Telephone | 501-766-3430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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