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General NPI Number Information
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NPI Number | 1083957781
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Entity Type | Organization
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Legal Business Name | HOMELY MEDICINE
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 01/16/2018
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Provider Practice Location Address
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Address Line | 5323 HARRY HINES BLVD
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City | DALLAS
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State | TX
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Zip | 75390-4600
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Country | US
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Telephone | 443-570-3397
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Fax |
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Provider Business Mailing Address
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Address Line | 300 STATE ST UNIT 93861
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1267
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Country | US
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Telephone | 443-570-3397
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | ADAM D'SOUZA
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Credential |
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Telephone | 443-570-3397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N8638
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License Number State | TX
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