Organization
THERESA M VAIL MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA MARIE VAIL MD (OWNER)
(903) 595-5500
Entity
Organization
Contact information
Practice address
606 S FLEISHEL AVE, TYLER, TX 75701-2012
(903) 595-5500
(903) 595-5506
Mailing address
606 S FLEISHEL AVE, TYLER, TX 75701-2012
(903) 595-5500
(903) 595-5506
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
L0672
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0076PW
BCBS
TX
05
—
168653701
—
TX
01
—
P00039903
RAILROAD MEDICARE
TX
Enumeration date
10/11/2006
Last updated
11/20/2014
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