Healthcare Provider Details

I. General information

NPI: 1982906244
Provider Name (Legal Business Name): CITYWIDE I D ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15800 DOOLEY RD SUITE 100
ADDISON TX
75001-4284
US

IV. Provider business mailing address

15800 DOOLEY RD SUITE 100
ADDISON TX
75001-4284
US

V. Phone/Fax

Practice location:
  • Phone: 972-239-3849
  • Fax: 972-934-4969
Mailing address:
  • Phone: 972-239-3849
  • Fax: 972-934-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLEN G REUBEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-282-7692