Provider Demographics
NPI:1073599874
Name:GYNECOLOGIC SPECIALISTS OF TEXARKANA LLP
Entity Type:Organization
Organization Name:GYNECOLOGIC SPECIALISTS OF TEXARKANA LLP
Other - Org Name:LIMITED LIABILITY PARTNERSHIP
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-792-6944
Mailing Address - Street 1:1114 OLIVE STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5226
Mailing Address - Country:US
Mailing Address - Phone:903-792-6944
Mailing Address - Fax:903-792-6213
Practice Address - Street 1:1114 ILOVE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5226
Practice Address - Country:US
Practice Address - Phone:903-792-6944
Practice Address - Fax:903-792-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6478207VG0400X
TXF1615207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00026ZMedicare ID - Type Unspecified