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General NPI Number Information
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NPI Number | 1154778280
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Entity Type | Individual
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Provider Name | JAMES ANTHONY DUTROW PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 5200 HARRY HINES BLVD
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City | DALLAS
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State | TX
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Zip | 75235-7709
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Country | US
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Telephone | 214-590-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1931 MARKET CENTER BLVD APT 3104
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City | DALLAS
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State | TX
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Zip | 75207-3504
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Country | US
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Telephone | 330-437-9922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10450
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License Number State | TX
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