Pure Radiance Laser Retreat

NPI #1013306273 in Tyler, Texas

Provider Information

NPI Number: 1013306273
Entity Type: Organization
Organization Name: Pure Radiance Laser Retreat
Primary Specialty: Family Medicine
Enumeration Date: Jan 12, 2015
Last Updated: Jan 12, 2015

Practice Location

Address: 6722 S BROADWAY AVE
City: Tyler
State: Texas
ZIP Code: 75703-4730
Phone: (903) 561-0300

Authorized Official

Name: DR. MACK D STEWART, M.D.
Title: OWNER/M.D.
Phone: (903) 561-0300

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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