Provider Demographics
NPI:1720858566
Name:NACOGDOCHES OBSTETRICS AND GYNECOLOGY PLLC
Entity Type:Organization
Organization Name:NACOGDOCHES OBSTETRICS AND GYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-569-0000
Mailing Address - Street 1:4800 NE STALLINGS DR STE 106
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1251
Mailing Address - Country:US
Mailing Address - Phone:936-569-0000
Mailing Address - Fax:833-645-2183
Practice Address - Street 1:4800 NE STALLINGS DR STE 106
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1251
Practice Address - Country:US
Practice Address - Phone:936-569-0000
Practice Address - Fax:833-645-2183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty