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General NPI Number Information
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NPI Number | 1922315696
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Entity Type | Organization
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Legal Business Name | PULMONARY MEDICINE OF NACOGDOCHES, P.A.
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 07/21/2011
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Provider Practice Location Address
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Address Line | 4848 NE STALLINGS DR STE. 100
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1239
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Country | US
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Telephone | 936-205-5960
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Fax |
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Provider Business Mailing Address
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Address Line | 4848 NE STALLINGS DR STE. 100
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1239
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Country | US
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Telephone | 936-205-5960
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LOYD GEORGE WHITLEY
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Credential | M.D.
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Telephone | 936-205-5960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | F6346
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License Number State | TX
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