Provider Demographics
NPI:1205874880
Name:EAST TEXAS PHYSICIAN'S ALLIANCE, LLP
Entity type:Organization
Organization Name:EAST TEXAS PHYSICIAN'S ALLIANCE, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-723-8800
Mailing Address - Street 1:PO BOX 4550
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-4550
Mailing Address - Country:US
Mailing Address - Phone:903-731-4700
Mailing Address - Fax:903-731-4699
Practice Address - Street 1:3201 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6901
Practice Address - Country:US
Practice Address - Phone:903-723-8800
Practice Address - Fax:903-723-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3192207Q00000X
TXF3795207Q00000X
TXD0378207Q00000X
TXK5388207Q00000X
TXJ1031207Q00000X
TXF1248207Q00000X
TXG3793207Q00000X
TXK5007207Q00000X
TXF6862207R00000X
TXE8773207R00000X
TXG6215207RC0000X
TXH7867207RG0100X
TXD3839207RP1001X
TXE54442085R0202X
TXK2184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127033201Medicaid
TX00N54FMedicare ID - Type Unspecified