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General NPI Number Information
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NPI Number | 1598772188
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Entity Type | Organization
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Legal Business Name | NACOGDOCHES GASTROENTEROLOGY, P.A.
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 1018 N MOUND ST SUITE 105
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4492
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Country | US
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Telephone | 936-569-6449
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Fax | 936-569-2458
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Provider Business Mailing Address
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Address Line | 1018 N MOUND ST SUITE 105
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4492
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Country | US
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Telephone | 936-569-6449
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Fax | 936-569-2458
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JILL GRIFFIN
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Credential |
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Telephone | 936-569-6449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | J3164
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License Number State | TX
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