Organization
VENOUS LASER CENTER OF EAST TEXAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY KEATON MD (PRESIDENT)
(903) 753-6500
Entity
Organization
Contact information
Practice address
903 N 4TH ST, LONGVIEW, TX 75601-5416
(903) 753-6500
(903) 247-0222
Mailing address
1602 PINE TREE RD, SUITE 3, LONGVIEW, TX 75604-3273
(903) 759-8886
(903) 247-0222
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0049MU
BLUE CROSS BLUE SHIELD TX
TX
Enumeration date
05/05/2006
Last updated
08/22/2020
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