MEDICARE: DAVID S GARTENBERG MDPA

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	261QP2300X	Primary Care Clinic/Center		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E9650	OTHER		TEXAS MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1528103975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID S GARTENBERG MDPA

Provider Business Mailing Address
First Line	:	4100 W 15TH ST
Second Line	:	SUITE #114
City	:	PLANO
State	:	TX
Zip	:	75093-5826
Country	:	US
Telephone Number	:	972-596-1205
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 W 15TH ST
Second Line	:	SUITE #114
City	:	PLANO
State	:	TX
Zip	:	75093-5826
Country	:	US
Telephone Number	:	972-596-1205
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID S GARTENBERG
Credential	:	MD
Telephone Number	:	972-596-1205

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	01/14/2009

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