Organization
EAST TEXAS VASCULAR ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAM HARRIS (PRACTICE ADMINISTRATOR)
(903) 595-2636
Entity
Organization
Contact information
Practice address
700 OLYMPIC PLAZA CIR STE 510, TYLER, TX 75701-1952
(903) 595-2636
(903) 595-5560
Mailing address
700 OLYMPIC PLAZA CIR STE 510, TYLER, TX 75701-1952
(903) 595-2636
(903) 595-5560
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
D4981
TX
208600000X
Surgery Physician
H4385
TX
208600000X
Surgery Physician
K0862
TX
208600000X
Surgery Physician
L1987
TX
2086S0129X
Vascular Surgery Physician
D4981
TX
2086S0129X
Vascular Surgery Physician
H4385
TX
2086S0129X
Vascular Surgery Physician
K0862
TX
2086S0129X
Vascular Surgery Physician
L1987
TX
208C00000X
Colon & Rectal Surgery Physician
H4385
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085672601
—
TX
Enumeration date
08/12/2005
Last updated
08/05/2020
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