Provider Demographics
NPI:1457669335
Name:JOHN M STRAYHORN MD PA
Entity Type:Organization
Organization Name:JOHN M STRAYHORN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STRAYHORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:903-794-3390
Mailing Address - Street 1:1002 TEXAS BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5113
Mailing Address - Country:US
Mailing Address - Phone:903-794-3390
Mailing Address - Fax:
Practice Address - Street 1:1002 TEXAS BLVD STE 400
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5113
Practice Address - Country:US
Practice Address - Phone:903-794-3390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2815207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114818103Medicaid