Healthcare Provider Details

I. General information

NPI: 1780851915
Provider Name (Legal Business Name): CARDIOVASCULAR SPECIALTY ASSOCIATES OF NORTH TEXAS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 W RALPH HALL PKWY SUITE 221
ROCKWALL TX
75032-6658
US

IV. Provider business mailing address

1320 GREENWAY DR SUITE 200
IRVING TX
75038-2503
US

V. Phone/Fax

Practice location:
  • Phone: 214-692-6135
  • Fax: 214-692-6265
Mailing address:
  • Phone: 972-550-9195
  • Fax: 972-550-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberM6717
License Number StateTX

VIII. Authorized Official

Name: DAVID J. CARTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 972-550-9195