Healthcare Provider Details

I. General information

NPI: 1265963854
Provider Name (Legal Business Name): EARWELL CENTERS OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 N CENTRAL EXPY STE 600
DALLAS TX
75231-5927
US

IV. Provider business mailing address

9101 N CENTRAL EXPY STE 600
DALLAS TX
75231-5927
US

V. Phone/Fax

Practice location:
  • Phone: 214-540-1428
  • Fax: 214-828-2609
Mailing address:
  • Phone: 214-540-1428
  • Fax: 214-828-2609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberD9379
License Number StateTX

VIII. Authorized Official

Name: HENRY STEPHENSON BYRD
Title or Position: MANAGER
Credential: M.D.
Phone: 214-821-9662