Healthcare Provider Details

I. General information

NPI: 1093754475
Provider Name (Legal Business Name): DALLAS COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MAPLE AVE # 6B
DALLAS TX
75235-8136
US

IV. Provider business mailing address

PO BOX 660599
DALLAS TX
75266-0599
US

V. Phone/Fax

Practice location:
  • Phone: 214-266-0110
  • Fax: 214-266-0113
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FREDRICK P. CERISE
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 214-590-8006