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General NPI Number Information
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NPI Number | 1184842064
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Entity Type | Individual
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Provider Name | DAVID RICHARD MISSIMO MD
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Gender | Male
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5824 W PLANO PKWY 104
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City | PLANO
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State | TX
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Zip | 75093-4636
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Country | US
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Telephone | 972-818-9355
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Fax | 972-818-9356
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Provider Business Mailing Address
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Address Line | 4608 STONEHOLLOW WAY
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City | DALLAS
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State | TX
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Zip | 75287-7522
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Country | US
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Telephone | 972-381-8618
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | JO133
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License Number State | TX
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