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General NPI Number Information
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NPI Number | 1104552165
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Entity Type | Organization
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Legal Business Name | PRIME NEUROCARE
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Dates
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Enumeration Date | 07/30/2022
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Last Update Date | 07/30/2022
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Provider Practice Location Address
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Address Line | 6201 DALLAS PKWY STE 210
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City | PLANO
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State | TX
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Zip | 75024-3529
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Country | US
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Telephone | 469-616-1922
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Fax | 469-519-1877
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Provider Business Mailing Address
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Address Line | 6201 DALLAS PKWY STE 210
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City | PLANO
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State | TX
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Zip | 75024-3529
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Country | US
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Telephone | 469-616-1922
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Fax | 469-519-1877
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Authorized Official
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Title or Position | OWNER
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Name | YU ZHAO
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Credential | MD
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Telephone | 901-335-4657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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