Healthcare Provider Details

I. General information

NPI: 1093899874
Provider Name (Legal Business Name): PEDIATRIC ALLERGY IMMUNOLOGY ASSOC.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 HILLCREST SUITE 150
FRISCO TX
75035-5418
US

IV. Provider business mailing address

7777 FOREST LN SUITE B332
DALLAS TX
75230-2571
US

V. Phone/Fax

Practice location:
  • Phone: 972-377-4025
  • Fax: 972-377-4022
Mailing address:
  • Phone: 972-566-7788
  • Fax: 972-566-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD L WASSERMAN
Title or Position: PRESIDENT
Credential: M.D., PHD
Phone: 972-566-7788