Healthcare Provider Details

I. General information

NPI: 1043487093
Provider Name (Legal Business Name): ELLIOT TVERYE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6606 LBJ FWY SUITE 200
DALLAS TX
75240-6533
US

IV. Provider business mailing address

PO BOX 650865
DALLAS TX
75265-0865
US

V. Phone/Fax

Practice location:
  • Phone: 972-715-5000
  • Fax: 972-715-9976
Mailing address:
  • Phone: 972-715-5000
  • Fax: 972-715-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberN6074
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: