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General NPI Number Information
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NPI Number | 1740720705
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Entity Type | Organization
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Legal Business Name | SAM RAYBURN VA
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 1201 E 9TH ST
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City | BONHAM
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State | TX
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Zip | 75418-4059
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Country | US
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Telephone | 903-583-1304
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 E 9TH ST
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City | BONHAM
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State | TX
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Zip | 75418-4059
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Country | US
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Telephone | 903-583-1304
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIETITIAN
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Name | KATHERINE FLOYD
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Credential | R.D.
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Telephone | 903-583-1304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | DT84636
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License Number State | TX
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