Provider Demographics
NPI:1922315696
Name:PULMONARY MEDICINE OF NACOGDOCHES, P.A.
Entity Type:Organization
Organization Name:PULMONARY MEDICINE OF NACOGDOCHES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOYD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-205-5960
Mailing Address - Street 1:4848 NE STALLINGS DR
Mailing Address - Street 2:STE. 100
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1239
Mailing Address - Country:US
Mailing Address - Phone:936-205-5960
Mailing Address - Fax:
Practice Address - Street 1:4848 NE STALLINGS DR
Practice Address - Street 2:STE. 100
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1239
Practice Address - Country:US
Practice Address - Phone:936-205-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6346207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB130183Medicare PIN