Healthcare Provider Details

I. General information

NPI: 1487774717
Provider Name (Legal Business Name): UNITED PARTNERS IN RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9090 SKILLMAN ST STE 182A PMB 371
DALLAS TX
75243-8278
US

IV. Provider business mailing address

9090 SKILLMAN ST # 182A PMB 371
DALLAS TX
75243
US

V. Phone/Fax

Practice location:
  • Phone: 214-358-1111
  • Fax: 972-669-1557
Mailing address:
  • Phone: 214-358-1111
  • Fax: 972-669-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberH9077
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberH9077
License Number StateTX

VIII. Authorized Official

Name: DR. JOHN D FISK
Title or Position: DOCTOR
Credential: M.D.
Phone: 214-358-1111