Organization
STEPHEN SOMERVILLE MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN PHILLIP SOMERVILLE M.D. (PRESIDENT)
(903) 758-5858
Entity
Organization
Contact information
Practice address
709 HOLLYBROOK DR, SUITE 5600, LONGVIEW, TX 75605-2470
(903) 758-5858
(903) 758-5864
Mailing address
709 HOLLYBROOK DR, SUITE 5600, LONGVIEW, TX 75605-2470
(903) 758-5858
(903) 758-5864
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01161942
AMERIGROUP
TX
05
—
168835001
—
TX
01
—
24LZ
BCBS-TX GROUP NUMBER
TX
Enumeration date
06/04/2006
Last updated
04/28/2008
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