1760565329 NPI number — MICAELA DARTSON DPM

Table of content: MICAELA DARTSON DPM (NPI 1760565329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760565329 NPI number — MICAELA DARTSON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DARTSON
Provider First Name:
MICAELA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1760565329
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 MAYWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75070-4393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-725-9663
Provider Business Mailing Address Fax Number:
972-548-1079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 MCEWEN RD
Provider Second Line Business Practice Location Address:
STE 625
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75244-5112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-221-9116
Provider Business Practice Location Address Fax Number:
214-219-1120
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1306 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 130986606 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0011AW . This is a "BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00606710 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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