Organization
EAST TEXAS KIDNEY SPECIALISTS,PA
Active
Other names
EAST TEXAS KIDNEY SPECIALISTS
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TIFFANY HAGOOD (PRACTICE ADMINISTRATOR)
(903) 234-9992
Entity
Organization
Contact information
Practice address
3535 N FOURTH ST STE 301, LONGVIEW, TX 75605-0037
(903) 234-9992
(903) 234-8287
Mailing address
3535 N FOURTH ST STE 301, LONGVIEW, TX 75605-0037
(903) 234-9992
(903) 234-8287
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0035GN
BLUE CROSS & BLUE SHIELD
TX
Enumeration date
04/18/2006
Last updated
10/06/2021
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