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Organization
NACOGDOCHES FAMILY PRACTICE, PA
Active
Organization
NACOGDOCHES FAMILY PRACTICE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWIN EMBORGO MD (OWNER)
(936) 564-2691
Entity
Organization
Contact information
Practice address
1023 N MOUND ST, SUITE A, NACOGDOCHES, TX 75961-4491
(936) 564-2691
(936) 560-5224
Mailing address
PO BOX 630696, NACOGDOCHES, TX 75963
(936) 553-2534
(713) 634-2636
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203713701
—
TX
01
—
M8458
TEXAS MEDICAL LICENSE
TX
Enumeration date
02/04/2008
Last updated
06/22/2010
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