Healthcare Provider Details

I. General information

NPI: 1790050375
Provider Name (Legal Business Name): DR ASSOCIATES OF NORTH TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 OHIO DR SUITE 130
PLANO TX
75093-3927
US

IV. Provider business mailing address

2301 OHIO DR SUITE 130
PLANO TX
75093-3927
US

V. Phone/Fax

Practice location:
  • Phone: 972-612-1305
  • Fax: 972-867-3402
Mailing address:
  • Phone: 972-612-1305
  • Fax: 972-867-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number23838
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number15435
License Number StateTX

VIII. Authorized Official

Name: DR. GARY B ROCHELLE
Title or Position: NEUROPSYCHOLOGIST
Credential: PHD
Phone: 972-612-1305