Provider Demographics
NPI:1215362710
Name:NORTHEAST TEXAS PEDIATRICS, PLLC
Entity type:Organization
Organization Name:NORTHEAST TEXAS PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:STAGG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-572-9823
Mailing Address - Street 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2338
Mailing Address - Country:US
Mailing Address - Phone:903-572-9823
Mailing Address - Fax:903-572-4812
Practice Address - Street 1:2001 MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2362
Practice Address - Country:US
Practice Address - Phone:903-572-9823
Practice Address - Fax:903-572-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty