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General NPI Number Information
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NPI Number | 1942538616
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Entity Type | Organization
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Legal Business Name | TEXAS SPECIALTY PHYSICIANS
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 2203 W LAMPASAS ST SUITE 205
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City | ENNIS
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State | TX
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Zip | 75119-5644
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Country | US
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Telephone | 785-843-2010
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Fax | 785-843-1639
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Provider Business Mailing Address
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Address Line | 2203 W LAMPASAS ST SUITE 205
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City | ENNIS
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State | TX
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Zip | 75119-5644
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Country | US
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Telephone | 785-843-2010
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Fax | 785-843-1639
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHNETTA TRAYLOR
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Credential |
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Telephone | 502-596-6063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | N5407
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License Number State | TX
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