Provider Demographics
NPI:1407932510
Name:EAST TEXAS PULMONARY ASSOCIATES OF LONGVIEW, PLLC
Entity Type:Organization
Organization Name:EAST TEXAS PULMONARY ASSOCIATES OF LONGVIEW, PLLC
Other - Org Name:EAST TEXAS PULMONARY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELHALWAGI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:903-315-2740
Mailing Address - Street 1:703 E MARSHALL AVE STE 3008
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5500
Mailing Address - Country:US
Mailing Address - Phone:903-315-2740
Mailing Address - Fax:903-315-2742
Practice Address - Street 1:703 E MARSHALL AVE STE 3008
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5500
Practice Address - Country:US
Practice Address - Phone:903-315-2740
Practice Address - Fax:903-315-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00696KMedicare PIN