Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2026-07-23
- Last updated
- 2026-07-23
Specialties
Licenses
- License TX
- 779046
Location
- Practice location
- 700 E MARSHALL AVE
- City
- LONGVIEW TX
- Postal code
- 756015580
- Phone
- 903-315-1500
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.