Provider Demographics
NPI:1750608832
Name:EDDY FURNISS, MD, PA
Entity type:Organization
Organization Name:EDDY FURNISS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBURN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FURNISS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:936-559-0700
Mailing Address - Street 1:4800 NE STALLINGS DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1249
Mailing Address - Country:US
Mailing Address - Phone:936-559-0700
Mailing Address - Fax:936-559-0500
Practice Address - Street 1:4800 NE STALLINGS DR
Practice Address - Street 2:SUITE 115
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1249
Practice Address - Country:US
Practice Address - Phone:936-559-0700
Practice Address - Fax:936-559-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10028866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty