Organization
EAST TEXAS MEDICAL SPECIALISTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY D. UPCHURCH M.D. (PARTNER)
(903) 315-2445
Entity
Organization
Contact information
Practice address
700 E MARSHALL AVE, LONGVIEW, TX 75601-5580
(903) 315-2000
Mailing address
9229 LYNDON B JOHNSON FWY, SUITE 250, DALLAS, TX 75243-3405
(972) 739-3097
(972) 739-2673
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008LT
BCBS
TX
05
—
165657101
—
TX
Enumeration date
07/08/2006
Last updated
06/10/2008
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