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General NPI Number Information
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NPI Number | 1124979950
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Entity Type | Organization
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Legal Business Name | CRESCENT DIRECT PRIMARY CARE PLLC
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Dates
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Enumeration Date | 02/06/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 2800 E HIGHWAY 114 STE 200
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City | TROPHY CLUB
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State | TX
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Zip | 76262-5306
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Country | US
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Telephone | 682-800-4727
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Fax |
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Provider Business Mailing Address
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Address Line | 23 DURANGO DR
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City | TROPHY CLUB
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State | TX
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Zip | 76262-5120
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ELVIRA JASAREVIC
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Credential | DO
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Telephone | 336-207-5677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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