Basic Information
| Provider Information | |||||||||
| NPI: | 1093741118 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAYLOR PATHOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4389 | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772104389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137984661 | ||||||||
| FaxNumber: | 7137986126 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 EAST MARSHALL AVENUE | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033152000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TITUS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR DIRECTOR OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7137984661 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.