Healthcare Provider Details

I. General information

NPI: 1174082150
Provider Name (Legal Business Name): CMDPN MEDICAL GROUP OF TEXAS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 09/17/2023
Certification Date: 09/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 OAK LAWN AVE, SUITE 1000 PMB 1123
DALLAS TX
75219
US

IV. Provider business mailing address

3838 OAK LAWN AVE, SUITE 1000 PMB 1123
DALLAS TX
75219
US

V. Phone/Fax

Practice location:
  • Phone: 720-996-0522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN DUTTON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 916-215-4554