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Organization
WISE COUNTY MEDICAL & SURGICAL ASSOCIATION
Active
Organization
WISE COUNTY MEDICAL & SURGICAL ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY CANNON NP (NURSE PRACTITIONER)
(817) 773-8938
Entity
Organization
Contact information
Practice address
1001 W EAGLE DR, DECATUR, TX 76234-3745
(940) 627-7443
Mailing address
1001 W EAGLE DR, DECATUR, TX 76234-3745
(940) 627-8982
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
AP130210
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP130210
NP LICENSE
TX
Enumeration date
02/12/2016
Last updated
02/16/2016
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