1326213414 NPI number — OB GYN ASSOCIATES OF DALLAS PLLC

Table of content: (NPI 1326213414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326213414 NPI number — OB GYN ASSOCIATES OF DALLAS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OB GYN ASSOCIATES OF DALLAS PLLC
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:
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:
1326213414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5600 W LOVERS LN
Provider Second Line Business Mailing Address:
SUITE 116-377
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75209-4330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-400-7284
Provider Business Mailing Address Fax Number:
214-276-4345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8305 WALNUT HILL LN
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231-4217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-363-5685
Provider Business Practice Location Address Fax Number:
214-276-4345
Provider Enumeration Date:
04/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BERTRAND
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
972-400-7284

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , 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)





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