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General NPI Number Information
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NPI Number | 1174313340
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Entity Type | Organization
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Legal Business Name | GRAND PRAIRIE PRIMARY CARE
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 5204 TX-360 SUITE 400 A
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City | GRAND PRARIE
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State | TX
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Zip | 75052
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Country | US
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Telephone | 972-755-1785
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Fax | 972-602-4522
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Provider Business Mailing Address
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Address Line | 6376 BIRDHILL LN
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City | FRISCO
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State | TX
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Zip | 75035-0796
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Country | US
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Telephone | 972-755-1785
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Fax | 972-602-4522
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SIREESHA JANGA
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Credential | MD
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Telephone | 972-322-7965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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