=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285980953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST PLANO DIABETES AND ENDOCRINE CENTER, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2012
-----------------------------------------------------
Last Update Date | 07/31/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6124 W PARKER RD SUITE 332
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-8122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-981-7812
-----------------------------------------------------
Fax | 972-981-7836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6124 W PARKER RD SUITE 332
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-8122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-981-7812
-----------------------------------------------------
Fax | 972-981-7836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JEFFREY H PERLMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 972-639-8799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | K6228
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------