Provider Demographics
NPI:1114149671
Name:D & F MED, PLLC
Entity Type:Organization
Organization Name:D & F MED, PLLC
Other - Org Name:GROVETON FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-642-0841
Mailing Address - Street 1:110 MAGEE
Mailing Address - Street 2:P O BOX 459
Mailing Address - City:GROVETON
Mailing Address - State:TX
Mailing Address - Zip Code:75845-4185
Mailing Address - Country:US
Mailing Address - Phone:936-642-0841
Mailing Address - Fax:936-309-0086
Practice Address - Street 1:110 MAGEE
Practice Address - Street 2:
Practice Address - City:GROVETON
Practice Address - State:TX
Practice Address - Zip Code:75845-4185
Practice Address - Country:US
Practice Address - Phone:936-642-0841
Practice Address - Fax:936-309-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 00013363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203876201Medicaid
TX673854Medicare PIN