Healthcare Provider Details

I. General information

NPI: 1629244660
Provider Name (Legal Business Name): DIRK A FRATER MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8230 WALNUT HILL LN SUITE 620
DALLAS TX
75231-4482
US

IV. Provider business mailing address

8230 WALNUT HILL LN SUITE 620
DALLAS TX
75231-4482
US

V. Phone/Fax

Practice location:
  • Phone: 214-373-3475
  • Fax: 214-373-3476
Mailing address:
  • Phone: 214-373-3475
  • Fax: 214-373-3476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH0992
License Number StateTX

VIII. Authorized Official

Name: CANDACE ADAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 214-373-3475