Healthcare Provider Details

I. General information

NPI: 1275507865
Provider Name (Legal Business Name): CARDIOLOGY CONSULTANTS OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 N HALL ST SUITE 400
DALLAS TX
75226-1339
US

IV. Provider business mailing address

PO BOX 660080
DALLAS TX
75266-0080
US

V. Phone/Fax

Practice location:
  • Phone: 214-824-5600
  • Fax:
Mailing address:
  • Phone: 214-824-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberF9632
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberD0393
License Number StateTX

VIII. Authorized Official

Name: DEBORAH GRAMBLING
Title or Position: COO
Credential:
Phone: 214-826-5000