1790706067 NPI number — DALLAS GASTROENTEROLOGY ASSOCIATES P A

Table of content: (NPI 1790706067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790706067 NPI number — DALLAS GASTROENTEROLOGY ASSOCIATES P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALLAS GASTROENTEROLOGY ASSOCIATES P A
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:
1790706067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 118377
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75011-8377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-820-7455
Provider Business Mailing Address Fax Number:
972-820-7640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4323 N JOSEY LN STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75010-4619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-820-7455
Provider Business Practice Location Address Fax Number:
972-820-7640
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OQAIL
Authorized Official First Name:
SYED
Authorized Official Middle Name:
MUHAMMAD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-820-7455

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  J6196 , 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: 0091NE . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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