Healthcare Provider Details

I. General information

NPI: 1932443140
Provider Name (Legal Business Name): ONSITE OCCMED PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 GREENVILLE AVE
DALLAS TX
75206-2912
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200 WEST
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 214-821-6007
  • Fax: 214-821-6149
Mailing address:
  • Phone: 972-364-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM TOM FOGARTY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 972-364-8000