Healthcare Provider Details

I. General information

NPI: 1811083702
Provider Name (Legal Business Name): INFECTIOUS DISEASE DOCTORS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6537 PRESTON RD
PLANO TX
75024-2610
US

IV. Provider business mailing address

PO BOX 802772
DALLAS TX
75380-2772
US

V. Phone/Fax

Practice location:
  • Phone: 972-484-7700
  • Fax: 469-729-6743
Mailing address:
  • Phone: 972-484-7700
  • Fax: 972-484-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: EVELYN AYALA
Title or Position: OFFICE MANAGER
Credential:
Phone: 972-484-7700