Organization
TEXOMA BRAIN AND SPINE SURGERY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL C MOLLESTON MD (NEUROSURGERON)
(601) 606-0979
Entity
Organization
Contact information
Practice address
5012 S US HIGHWAY 75 STE 220, DENISON, TX 75020-4598
(903) 416-6460
(866) 291-0393
Mailing address
5012 S US HIGHWAY 75 STE 220, DENISON, TX 75020-4598
(903) 416-6460
(866) 291-0393
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
14374
MS
173000000X
Legal Medicine
14374MS
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05783854
—
MS
Enumeration date
06/02/2006
Last updated
08/15/2016
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