Provider Demographics
NPI:1164537247
Name:LEDET, TED WILLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:WILLIS
Last Name:LEDET
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4848 NE STALLINGS DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965
Mailing Address - Country:US
Mailing Address - Phone:936-569-0304
Mailing Address - Fax:936-552-0232
Practice Address - Street 1:4848 NE STALLINGS DR
Practice Address - Street 2:SUITE 106
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1239
Practice Address - Country:US
Practice Address - Phone:936-569-0304
Practice Address - Fax:936-552-0232
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-07-01
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Provider Licenses
StateLicense IDTaxonomies
TXG9144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123232401OtherTPI
TX000000GR74OtherBLUE CROSS
TXP000GR742Medicaid
TX340001471OtherRR MEDICARE
TX123232401OtherTPI
TX000000GR74OtherBLUE CROSS
TX340001471OtherRR MEDICARE