Healthcare Provider Details

I. General information

NPI: 1063472991
Provider Name (Legal Business Name): ANDREW J APPLEWHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE SUITE 210 BARNETT
DALLAS TX
75246-2017
US

IV. Provider business mailing address

PO BOX 225971
DALLAS TX
75222-5971
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-4400
  • Fax: 214-820-4422
Mailing address:
  • Phone: 972-786-0140
  • Fax: 972-786-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL5228
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberL5228
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: