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General NPI Number Information
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NPI Number | 1164771465
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Entity Type | Organization
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Legal Business Name | ENDOCRINOLOGY AND DIABETES SPECIALIST PA
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 12222 N CENTRAL EXPY SUITE 200
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City | DALLAS
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State | TX
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Zip | 75243-3755
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Country | US
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Telephone | 214-316-2447
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 COIT RD STE 208C
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City | PLANO
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State | TX
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Zip | 75075-6140
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Country | US
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Telephone | 972-998-6711
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Fax | 877-465-4613
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Authorized Official
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Title or Position | OWNER
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Name | MARYAM ZAMANIAN
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Credential | MD
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Telephone | 972-998-6711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | M0612
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License Number State | TX
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