Provider Demographics
NPI:1033343611
Name:LILES, NATHAN DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:DANIEL
Last Name:LILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 E DAWSON
Mailing Address - Street 2:PATHOLOGY
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701
Mailing Address - Country:US
Mailing Address - Phone:903-606-7494
Mailing Address - Fax:903-606-2729
Practice Address - Street 1:800 E. DAWSON
Practice Address - Street 2:TRINITY MOTHER FRANCES HOSPITAL
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:512-814-0298
Practice Address - Fax:512-597-2713
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2174207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2160947Medicaid
TXTXB109244OtherMEDICARE