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General NPI Number Information
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NPI Number | 1134445190
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Entity Type | Organization
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Legal Business Name | D MEDICAL
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 4431 W WALNUT ST
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City | GARLAND
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State | TX
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Zip | 75042-4107
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Country | US
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Telephone | 972-272-1880
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Fax | 972-276-1886
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Provider Business Mailing Address
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Address Line | 12200 PARK CENTRAL DR STE 100
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City | DALLAS
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State | TX
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Zip | 75251-2124
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Country | US
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Telephone | 972-701-0199
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Fax | 972-701-0201
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Authorized Official
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Title or Position | ASST OFFICE ADMINISTRATOR
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Name | VALENCIA JOHNSON
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Credential |
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Telephone | 972-701-0199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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