Organization
EASTERN TEXAS PATHOLOGY LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES R. OGBURN JR. M.D. (PATHOLOGIST)
(903) 675-0080
Entity
Organization
Contact information
Practice address
134 ROSEDALE DR, ATHENS, TX 75751-3625
(903) 675-0080
(903) 675-0081
Mailing address
134 ROSEDALE DR, ATHENS, TX 75751-3625
(903) 675-0080
(903) 675-0081
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
J2242
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0085PV
BCBS
TX
Enumeration date
03/19/2007
Last updated
09/16/2014
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