Organization Name: | UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER-FACILITY-PHYSICIAN |
NPI Number: | 1063400778 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | VERNON MOORE (VP FOR FINANCE AND ADMINISTRATION) |
Mailing Address: | 11937 Us Highway 271 Tyler |
State: | TX US |
Postal Code: | 757083154 |
Phone Number: | 9038773451 |
Fax Number: | |
NPI Enumeration Date: | 10/07/2005 |
NPI Last Update Date: | 07/08/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |