MEDICARE: VERSOAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1073129276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERSOAL, PLLC

Provider Business Mailing Address
First Line	:	6009 W PARKER RD STE 149-389
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-8120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2459 E HEBRON PKWY STE 100
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4477
Country	:	US
Telephone Number	:	469-971-3188
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VAHEH DAVOUDIAN
Credential	:
Telephone Number	:	469-971-3188

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	10/07/2020

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