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General NPI Number Information
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NPI Number | 1699288811
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Entity Type | Organization
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Legal Business Name | TEXAS EMERGENCY GROUP LLC
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 2550 N ESPLANADE ST
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City | CUERO
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State | TX
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Zip | 77954-4736
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Country | US
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Telephone | 361-275-6191
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 207307
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City | DALLAS
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State | TX
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Zip | 75320-7307
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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 | GRANT DOUGLASS
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Credential |
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Telephone | 800-929-4854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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