Healthcare Provider Details

I. General information

NPI: 1194990515
Provider Name (Legal Business Name): LINDA A DULTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD STE 514
DALLAS TX
75390-0005
US

IV. Provider business mailing address

5323 HARRY HINES BLVD
DALLAS TX
75390-9158
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-3917
  • Fax:
Mailing address:
  • Phone: 214-648-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD79584
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR3664
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: