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General NPI Number Information
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NPI Number | 1164646931
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Entity Type | Organization
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Legal Business Name | ALLIANCE FAMILY MEDICINE PA
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 17610 PRESTON RD
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City | DALLAS
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State | TX
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Zip | 75252
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Country | US
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Telephone | 972-931-0100
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Fax | 972-931-0400
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Provider Business Mailing Address
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Address Line | 17610 PRESTON RD
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City | DALLAS
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State | TX
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Zip | 75252-5734
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Country | US
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Telephone | 972-931-0100
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Fax | 972-931-0400
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Authorized Official
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Title or Position | PRESIDENT
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Name | HANIA ALAIDROOS
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Credential | M.D.
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Telephone | 972-931-0100
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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 | L9058
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License Number State | TX
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