Healthcare Provider Details

I. General information

NPI: 1043233604
Provider Name (Legal Business Name): JOHN A DEMOPULOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN STE B216
DALLAS TX
75230
US

IV. Provider business mailing address

7777 FOREST LN STE B216
DALLAS TX
75230-6810
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-8380
  • Fax: 972-566-8330
Mailing address:
  • Phone: 972-566-8380
  • Fax: 972-566-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberH8543
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH8543
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: