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Organization
EAST TEXAS OUT-PATIENT PLLC
Active
Organization
EAST TEXAS OUT-PATIENT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY W DAILEY (OWNER)
(903) 567-1910
Entity
Organization
Contact information
Practice address
116 N HOUSTON ST, EDGEWOOD, TX 75117-1555
(903) 962-3419
(903) 385-3340
Mailing address
PO BOX 76, CANTON, TX 75103-0076
(903) 962-3419
(903) 962-3635
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
04/24/2019
Last updated
07/01/2025
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