Healthcare Provider Details

I. General information

NPI: 1952568453
Provider Name (Legal Business Name): DCOA PHYSICIAN ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ORCHARD DR STE A
ARLINGTON TX
76012-2519
US

IV. Provider business mailing address

5416 EDGEHOLLOW PL
DALLAS TX
75287-7505
US

V. Phone/Fax

Practice location:
  • Phone: 817-855-1035
  • Fax:
Mailing address:
  • Phone: 214-802-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL D LYDE
Title or Position: SECRETARY
Credential: MD
Phone: 214-681-4913