Healthcare Provider Details

I. General information

NPI: 1366460164
Provider Name (Legal Business Name): PRIGOFF-BOWERS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 S HAMPTON RD STE B102
DALLAS TX
75224
US

IV. Provider business mailing address

2909 S HAMPTON RD STE B102
DALLAS TX
75224
US

V. Phone/Fax

Practice location:
  • Phone: 214-337-8949
  • Fax: 214-339-0090
Mailing address:
  • Phone: 214-337-8949
  • Fax: 214-339-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1377
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0349
License Number StateTX

VIII. Authorized Official

Name: CHRIS BOWERS
Title or Position: DPM
Credential: DPM
Phone: 214-337-8949