Organization
EAST TEXAS INTERNAL MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORIS SHIPLEY (OFFICE MANAGER)
(936) 634-3995
Entity
Organization
Contact information
Practice address
515 GASLIGHT BLVD, LUFKIN, TX 75904-3127
(936) 634-3995
Mailing address
515 GASLIGHT BLVD, LUFKIN, TX 75904-3127
(936) 634-3995
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196347201
—
TX
Enumeration date
02/21/2008
Last updated
08/11/2011
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