=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316116882
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARY TANAMACHI, M.D. ASSOC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2008
-----------------------------------------------------
Last Update Date | 07/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 N BELT LINE RD SUITE 101
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75149-1770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-288-4429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1010 N BELT LINE RD SUITE 101
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75149-1770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-288-4429
-----------------------------------------------------
Fax | 972-288-9380
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SURGEON
-----------------------------------------------------
Name | DR. CARY T TANAMACHI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 972-288-4429
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | D9684
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------