MEDICARE: OAKCLIFF OB-GYN ASSOCIATES

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1891911582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKCLIFF OB-GYN ASSOCIATES

Provider Business Mailing Address
First Line	:	1801 N HAMPTON RD
Second Line	:	STE. 200
City	:	DESOTO
State	:	TX
Zip	:	75115-2391
Country	:	US
Telephone Number	:	972-780-8009
Fax Number	:	972-780-6115

Provider Business Practice Location Address
First Line	:	3111 SYLVAN AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75212-4028
Country	:	US
Telephone Number	:	972-780-8009
Fax Number	:	972-780-6115

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MISS STEPHANIE MEDINA
Credential	:
Telephone Number	:	972-780-8009

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	08/22/2020

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