| NPI | 1649226879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA M TILLMAN Director Central Credentialing And 903-531-5784 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2025-09-11 |