Provider Demographics
NPI:1790043024
Name:STRIPLING CLINIC
Entity Type:Organization
Organization Name:STRIPLING CLINIC
Other - Org Name:MARCUS ALAN BYRD MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-592-8101
Mailing Address - Street 1:PO BOX 8298
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-8298
Mailing Address - Country:US
Mailing Address - Phone:903-284-6162
Mailing Address - Fax:903-284-6163
Practice Address - Street 1:555 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-2414
Practice Address - Country:US
Practice Address - Phone:903-284-6162
Practice Address - Fax:903-284-6163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty