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Organization

TENNISON CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DOUGLAS K TENNISON MD (OWNER)
(409) 385-7245
Entity
Organization

Contact information

Practice address
445 ROOSEVELT DR, SILSBEE, TX 77656-3529
(409) 385-7245
(409) 385-2494
Mailing address
445 ROOSEVELT DR, SILSBEE, TX 77656-3529
(409) 385-7245
(409) 385-2494

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E2371
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0034KY
BLUECROSS BLUESHIELD OF TEXAS
TX
05
112046101
TX
05
112046102
TX
Enumeration date
01/21/2009
Last updated
01/21/2009
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