MEDICARE: DALLAS 365, 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	208D00000X	General Practice Physician
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1932660636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS 365, PLLC

Provider Business Mailing Address
First Line	:	13101 PRESTON RD # 110648
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-5237
Country	:	US
Telephone Number	:	512-422-0633
Fax Number	:	469-802-0070

Provider Business Practice Location Address
First Line	:	13101 PRESTON RD # 110648
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-5237
Country	:	US
Telephone Number	:	512-422-0633
Fax Number	:	469-802-0700

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JEFFERY FRITZ
Credential	:	MD
Telephone Number	:	512-422-0633

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	05/04/2026

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