MEDICARE: NORTHWEST DALLAS FAMILY MEDICAL ASSOCIATION, P.A.

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	363LF0000X	Family Nurse Practitioner		TX
2	207Q00000X	Family Medicine Physician		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659327773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST DALLAS FAMILY MEDICAL ASSOCIATION, P.A.

Provider Business Mailing Address
First Line	:	3464 WEBB CHAPEL EXT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-6751
Country	:	US
Telephone Number	:	214-528-4053
Fax Number	:	214-528-4056

Provider Business Practice Location Address
First Line	:	3464 WEBB CHAPEL EXT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-6751
Country	:	US
Telephone Number	:	214-528-4053
Fax Number	:	214-528-4056

Authorized Official
Title or Position	:	COO
Name	:	JAMES W. BLAMER
Credential	:
Telephone Number	:	214-333-7333

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	02/04/2014

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