Healthcare Provider Details

I. General information

NPI: 1265744007
Provider Name (Legal Business Name): DCOA PHYSICIAN ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 WALKER BLVD STE 121
NORTH RICHLAND HILLS TX
76180-0903
US

IV. Provider business mailing address

6021 WALKER BLVD STE 121
NORTH RICHLAND HILLS TX
76180-0903
US

V. Phone/Fax

Practice location:
  • Phone: 832-237-3500
  • Fax: 832-237-0200
Mailing address:
  • Phone: 832-237-3500
  • Fax: 832-237-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number800382392
License Number StateTX

VIII. Authorized Official

Name: TINA JOHNSON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 832-237-3500