Healthcare Provider Details

I. General information

NPI: 1144230673
Provider Name (Legal Business Name): THEODORE SUGIHARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 MATLOCK RD
ARLINGTON TX
76018-1532
US

IV. Provider business mailing address

5421 MATLOCK RD
ARLINGTON TX
76018-1532
US

V. Phone/Fax

Practice location:
  • Phone: 817-460-7447
  • Fax:
Mailing address:
  • Phone: 817-460-7447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberK1080
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: