Healthcare Provider Details

I. General information

NPI: 1871504209
Provider Name (Legal Business Name): JOHN P. MEEHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD #116A
DALLAS TX
75216-7167
US

IV. Provider business mailing address

4500 S LANCASTER RD #116A
DALLAS TX
75216-7167
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-0722
  • Fax: 214-857-0911
Mailing address:
  • Phone: 214-857-0722
  • Fax: 214-857-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberH7791
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: