Healthcare Provider Details

I. General information

NPI: 1104136928
Provider Name (Legal Business Name): METRO EAR NOSE AND THROAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4708 ALLIANCE BOULEVARD PAVILLION 1 SUITE#860
PLANO TX
75093-5340
US

IV. Provider business mailing address

4104 JUNIUS STREET
DALLAS TX
75246-1427
US

V. Phone/Fax

Practice location:
  • Phone: 214-742-2194
  • Fax: 214-827-0162
Mailing address:
  • Phone: 214-742-2194
  • Fax: 214-827-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD9259
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. FRED DELANO OWENS
Title or Position: CEO
Credential: MD
Phone: 214-742-2194