Provider Demographics
NPI:1376856161
Name:GERALD J AKPASSA MD PA
Entity Type:Organization
Organization Name:GERALD J AKPASSA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:AKPASSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:903-693-8504
Mailing Address - Street 1:1029 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-6228
Mailing Address - Country:US
Mailing Address - Phone:903-693-8504
Mailing Address - Fax:480-705-7301
Practice Address - Street 1:4054 NW LOOP
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-3346
Practice Address - Country:US
Practice Address - Phone:903-693-8504
Practice Address - Fax:480-705-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447296975OtherNPI