=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275022584
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DFW RADIOLOGY ASSOCIATES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2018
-----------------------------------------------------
Last Update Date | 03/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12840 HILLCREST RD STE E-104
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230-1528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-838-6440
-----------------------------------------------------
Fax | 214-838-6441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6125 LUTHER LN # 321
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75225-6202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-838-6440
-----------------------------------------------------
Fax | 214-838-6441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPAL MEMBER
-----------------------------------------------------
Name | DR. SUZANNE SLONIM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 214-773-1524
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number | L0606
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------