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General NPI Number Information
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NPI Number | 1154433746
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Entity Type | Organization
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Legal Business Name | GENESIS RADIOLOGY, P.A.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 2828 W PARKER RD
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City | PLANO
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State | TX
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Zip | 75075-9153
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Country | US
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Telephone | 972-599-1860
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 864768
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City | PLANO
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State | TX
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Zip | 75086-4768
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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 | MEDICAL DIRECTOR
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Name | ALBERT TESORIERO
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Credential |
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Telephone | 972-599-1860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G7011
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License Number State | TX
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