Individual
ROGER DALE HOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 SUMMERHILL RD, SUITE A, TEXARKANA, TX 75501-3570
(903) 792-4779
(903) 792-4693
Mailing address
2401 SUMMERHILL RD, SUITE A, TEXARKANA, TX 75501-3570
(903) 792-4779
(903) 792-4693
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J1266
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102969001
—
AR
05
—
1153256-04
—
TX
Enumeration date
05/18/2006
Last updated
02/08/2011
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