Healthcare Provider Details

I. General information

NPI: 1902241292
Provider Name (Legal Business Name): TR DIAGNOSTIC RADIOLOGY MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 N JOSEY LN STE 116
CARROLLTON TX
75007-3151
US

IV. Provider business mailing address

3620 N JOSEY LN STE 116
CARROLLTON TX
75007-3151
US

V. Phone/Fax

Practice location:
  • Phone: 972-474-8989
  • Fax: 469-763-3123
Mailing address:
  • Phone: 972-474-8989
  • Fax: 469-763-3123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TATIANA DOWD
Title or Position: CEO
Credential:
Phone: 972-474-8989