Healthcare Provider Details

I. General information

NPI: 1487726352
Provider Name (Legal Business Name): DALLAS FAMILY MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 LOWER DALLAS HWY
DALLAS NC
28034-9368
US

IV. Provider business mailing address

824 LOWER DALLAS HWY
DALLAS NC
28034-9368
US

V. Phone/Fax

Practice location:
  • Phone: 704-874-0200
  • Fax: 704-874-0201
Mailing address:
  • Phone: 704-874-0200
  • Fax: 704-874-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDITH ANNE WARE
Title or Position: OFFICE MANAGER
Credential:
Phone: 704-874-0205