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General NPI Number Information
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NPI Number | 1912442757
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Entity Type | Organization
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Legal Business Name | PRO-SOM, PLLC
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 2200 KELL BLVD
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City | WICHITA FALLS
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State | TX
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Zip | 76309-4401
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Country | US
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Telephone | 940-764-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 2106 CLARINDA AVE
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City | WICHITA FALLS
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State | TX
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Zip | 76308-1224
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Country | US
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Telephone | 940-781-3013
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RALPH CHANDLER HARVEY
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Credential | M.D.
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Telephone | 940-781-3013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | N0085
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License Number State | TX
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