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General NPI Number Information
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NPI Number | 1124501523
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Entity Type | Organization
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Legal Business Name | SELJAY OPERATIONS LLC
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 106 HILLCREST ST
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City | LAKE DALLAS
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State | TX
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Zip | 75065-2330
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Country | US
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Telephone | 181-756-9006
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Fax | 979-481-5221
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Provider Business Mailing Address
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Address Line | 106 HILLCREST ST
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City | LAKE DALLAS
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State | TX
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Zip | 75065-2330
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Country | US
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Telephone | 181-756-9006
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Fax | 979-481-5221
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID BRILEY
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Credential |
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Telephone | 817-569-0067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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