Healthcare Provider Details

I. General information

NPI: 1003913609
Provider Name (Legal Business Name): PRITI B. VYAS; M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2006
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W NASH ST
TERRELL TX
75160-2509
US

IV. Provider business mailing address

PO BOX 856
TERRELL TX
75160-0014
US

V. Phone/Fax

Practice location:
  • Phone: 972-563-6493
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PRITI B. VYAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 972-563-6493