Organization
HEATON EAR NOSE AND THROAT ASSOCIATES OF EAST TEXAS P A
Active
Other names
ENT Associates of East Texas
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA GAMBLE (BILLING MANAGER)
(903) 592-5601
Entity
Organization
Contact information
Practice address
1136 E GRANDE BLVD, TYLER, TX 75703-3982
(903) 592-5601
(903) 595-3304
Mailing address
1136 E GRANDE BLVD, TYLER, TX 75703-3982
(903) 592-5601
(903) 595-3304
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T02E
BCBS
TX
05
—
085099201
—
TX
01
—
CA8539
PALMETTO, RR MEDICARE
TX
Enumeration date
02/12/2007
Last updated
03/22/2019
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