Healthcare Provider Details

I. General information

NPI: 1912327776
Provider Name (Legal Business Name): LIBERTY SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 01/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 N DALLAS PKWY SUITE 800
PLANO TX
75024-7144
US

IV. Provider business mailing address

6900 N DALLAS PKWY SUITE 800
PLANO TX
75024-7144
US

V. Phone/Fax

Practice location:
  • Phone: 214-396-7725
  • Fax: 214-396-7725
Mailing address:
  • Phone: 214-396-7725
  • Fax: 214-396-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DUSTIN RAY
Title or Position: OWNER
Credential: M.D.
Phone: 214-315-6432