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General NPI Number Information
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NPI Number | 1285978098
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Entity Type | Organization
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Legal Business Name | NEUROSURGICAL PAS OF NORTH TEXAS, PA
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 4461 COIT RD. SUITE 405
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City | FRISCO
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State | TX
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Zip | 75035
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Country | US
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Telephone | 972-377-9200
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Fax | 972-377-9300
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Provider Business Mailing Address
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Address Line | 4461 COIT RD. SUITE 405
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City | FRISCO
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State | TX
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Zip | 75035
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Country | US
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Telephone | 972-377-9200
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Fax | 972-377-9300
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH KEITH PRESTON
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Credential | MD
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Telephone | 972-377-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA07772
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA06349
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA05731
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA07007
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License Number State | TX
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