1730569872 NPI number — QUAN DANG LE MD PA

Table of content: (NPI 1730569872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730569872 NPI number — QUAN DANG LE MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUAN DANG LE MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DFW PAIN SPORTS AND SPINE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730569872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1917 PARK AVE N
Provider Second Line Business Mailing Address:
210
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76010-0884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-777-5211
Provider Business Mailing Address Fax Number:
817-556-0148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 N CARRIER PKWY
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
GRAND PRAIRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75050-5476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-777-5211
Provider Business Practice Location Address Fax Number:
817-556-0148
Provider Enumeration Date:
06/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
QUAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
214-714-7577

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  P8048 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: MD203006 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: P8048 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: MD203006 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: P8048 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: MD203006 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: P8048 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0014X , with the licence number: MD203006 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005AAA . This is a "TX BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00S5S5 . This is a "GRP BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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