Organization
EAST TEXAS INFECTIOUS DISEASE CONSULTANTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL CONOVER (ADMINISTRATOR)
(903) 592-4473
Entity
Organization
Contact information
Practice address
935 S BAXTER AVE, STE 103, TYLER, TX 75701-2245
(903) 592-4473
(903) 592-4474
Mailing address
PO BOX 131629, TYLER, TX 75713-1629
(903) 592-4473
(903) 592-4474
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
207R10200X
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157701701
—
TX
Enumeration date
07/28/2005
Last updated
04/02/2008
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