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>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1750364188

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
110 MAGEE  GROVETON, TX 75845-4185 US
Tel: 936-642-0841  Fax: 936-642-0849

Contact information for business:
Tel: 936-642-0841  Fax: 936-642-0849

Registration Information:
NPI: 1750364188
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
TXPA 02393

Legacy codes, insurance codes and state license numbers:



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