Shepherd Rural Health Clinic PA

NPI #1376629212 in Shepherd, Texas

Provider Information

NPI Number: 1376629212
Entity Type: Organization
Organization Name: Shepherd Rural Health Clinic PA
Primary Specialty: Physician Assistant
Enumeration Date: Oct 31, 2006
Last Updated: Aug 30, 2010

Practice Location

Address: 11 WOODLAND PARK DRIVE
City: Shepherd
State: Texas
ZIP Code: 77371
Phone: (936) 628-3343

Authorized Official

Name: DR. PHILIP R WISIACKAS, MD
Title: PHYSICIAN
Phone: (936) 628-3343

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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