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General NPI Number Information
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NPI Number | 1801958665
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Entity Type | Organization
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Legal Business Name | EAST TEXAS CLINIC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 WILLIS AVE
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City | NAPLES
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State | TX
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Zip | 75568
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Country | US
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Telephone | 903-897-5684
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Fax | 903-897-5339
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Provider Business Mailing Address
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Address Line | PO BOX 250
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City | NAPLES
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State | TX
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Zip | 75568
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Country | US
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Telephone | 903-897-5684
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Fax |
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Authorized Official
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Title or Position | FAMILY PRACTICE
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Name | JAMES PATRICK GRIFFIN
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Credential | MD
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Telephone | 903-897-5684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA03991
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License Number State | TX
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