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Organization
SPINE & JOINT PHYSICIAN ASSOCIATES
Active
Organization
SPINE & JOINT PHYSICIAN ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENETHA D MORAN (OFFICER / AUTHORIZED OFFICIAL)
(972) 763-3893
Entity
Organization
Contact information
Practice address
1814 ROSELAND BLVD, TYLER, TX 75701-4234
(903) 525-3330
Mailing address
1814 ROSELAND BLVD, TYLER, TX 75701-4234
(903) 525-3330
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
802145828
TEXAS SOS FILING NUMBER
—
Enumeration date
08/31/2017
Last updated
07/21/2022
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