Provider Demographics
NPI:1780708008
Name:DIGESTIVE DISEASE CENTER
Entity type:Organization
Organization Name:DIGESTIVE DISEASE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-785-0025
Mailing Address - Street 1:2870 LEWIS LN STE 230
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-9380
Mailing Address - Country:US
Mailing Address - Phone:903-785-0025
Mailing Address - Fax:903-784-4140
Practice Address - Street 1:2870 LEWIS LN STE 230
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9380
Practice Address - Country:US
Practice Address - Phone:903-785-0025
Practice Address - Fax:903-784-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2552174400000X
TXF5053174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP3177OtherMEDICARE RAILROAD
TX112850602Medicaid
TX00KB19Medicare PIN