MEDICARE: PRESTIGE PRIMARY CARE, 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	207R00000X	Internal Medicine Physician	N2391	TX

General Provider Information

NPI Number	:	1912248881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE PRIMARY CARE, P.A.

Provider Business Mailing Address
First Line	:	6029 BELT LINE RD STE 105
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-7873
Country	:	US
Telephone Number	:	972-385-0000
Fax Number	:	972-385-1231

Provider Business Practice Location Address
First Line	:	6029 BELT LINE RD STE 105
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-7873
Country	:	US
Telephone Number	:	972-385-0000
Fax Number	:	972-385-1231

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ASIF AZIZ
Credential	:	M.D.
Telephone Number	:	408-910-0840

Provider Enumeration Date	:	03/02/2013
Last Update Date	:	06/11/2015

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