Healthcare Provider Details

I. General information

NPI: 1588488571
Provider Name (Legal Business Name): IPA ER GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 E HIGHWAY 114
TROPHY CLUB TX
76262-5302
US

IV. Provider business mailing address

6901 SNIDER PLZ STE 130
DALLAS TX
75205-5649
US

V. Phone/Fax

Practice location:
  • Phone: 214-696-8033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW F DAVIS
Title or Position: PRESIDENT
Credential:
Phone: 214-696-8033