=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780866673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERVE D. HOSEK M D
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2007
-----------------------------------------------------
Last Update Date | 12/03/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 913 COTTONWOOD DR
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75090-2831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-868-9565
-----------------------------------------------------
Fax | 903-893-8916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 913 COTTONWOOD DR
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75090-2831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-868-9565
-----------------------------------------------------
Fax | 903-893-8916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC MANAGER
-----------------------------------------------------
Name | DONNA J GAGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-868-9565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | H4962
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------