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General NPI Number Information
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NPI Number | 1356772206
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Entity Type | Organization
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Legal Business Name | PERITUS MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 07/18/2014
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Provider Practice Location Address
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Address Line | 9301 N CENTRAL EXPY # 345
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City | DALLAS
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State | TX
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Zip | 75231-0806
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Country | US
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Telephone | 972-408-2777
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Fax | 972-692-0514
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Provider Business Mailing Address
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Address Line | 17111 PRESTON RD STE 100
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City | DALLAS
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State | TX
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Zip | 75248-1234
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Country | US
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Telephone | 972-588-1050
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Fax | 972-588-1041
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Authorized Official
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Title or Position | CFO
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Name | MR. LARRY J BRAYTON
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Credential |
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Telephone | 972-588-1050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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