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General NPI Number Information
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NPI Number | 1881897114
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Entity Type | Organization
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Legal Business Name | FOUR SEASONS WOMEN'S HEALTH PA
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | 2017 RICKETY LN
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City | TYLER
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State | TX
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Zip | 75703-1706
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Country | US
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Telephone | 903-533-8811
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Fax | 903-593-5511
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Provider Business Mailing Address
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Address Line | 2017 RICKETY LN
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City | TYLER
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State | TX
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Zip | 75703-1706
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Country | US
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Telephone | 903-533-8811
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Fax | 903-593-5511
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS JONI N CORTEZ
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Credential |
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Telephone | 903-533-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 207V00000X
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License Number State | TX
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