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2100 S Mobberly Ave Longview TX 75602-3564 | |
(903) 233-3760 | |
(972) 367-3451 |
Full Name | |
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Speciality | Family Medicine |
Location | 2100 S Mobberly Ave, Longview, Texas |
Authorized Official Name and Position | Mouzon Bass (AGENT) |
Authorized Official Contact | 18005559073 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5050 Spring Valley Rd Dallas TX 75244-3995 Ph: (800) 555-9073 | 2100 S Mobberly Ave Longview TX 75602-3564 Ph: (903) 233-3760 |
NPI Number | 1932598513 |
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Provider Enumeration Date | 01/20/2015 |
Last Update Date | 01/20/2015 |
Identifier | Type | State | Issuer |
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1932598513 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Secondary |
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