Healthcare Provider Details

I. General information

NPI: 1790956464
Provider Name (Legal Business Name): DCOA PHYSICIAN ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NEC LITCHFIELD & MCDOWELL ROAD BUILDING A SUITE 104
GOODYEAR AZ
85338
US

IV. Provider business mailing address

3 RIVERWAY SUITE 825
HOUSTON TX
77056-1919
US

V. Phone/Fax

Practice location:
  • Phone: 832-237-3500
  • Fax: 832-237-0200
Mailing address:
  • Phone: 713-840-5245
  • Fax: 281-897-9906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: TINA JOHNSON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 713-840-5245