Healthcare Provider Details

I. General information

NPI: 1093928970
Provider Name (Legal Business Name): FAMILY DOCTORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 TEASLEY LN
DENTON TX
76205
US

IV. Provider business mailing address

1512 TEASLEY LN
DENTON TX
76205
US

V. Phone/Fax

Practice location:
  • Phone: 940-566-5010
  • Fax: 940-382-0980
Mailing address:
  • Phone: 940-566-5010
  • Fax: 940-382-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. RANDALL S MARR
Title or Position: ADMINISTRATOR
Credential: MHA PAC
Phone: 940-566-5010