=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366693319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELDA J. SETLIFF, M.D. ,P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2008
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5959 HARRY HINES BLVD SUITE 1104
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75235-6233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-630-5191
-----------------------------------------------------
Fax | 214-688-1136
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1420 W MOCKINGBIRD LN STE 470
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75247-4931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-630-5191
-----------------------------------------------------
Fax | 214-688-1136
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. RELDA JEANNE SETLIFF
-----------------------------------------------------
Credential | MD, PA
-----------------------------------------------------
Telephone | 214-630-5191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number | G5657-1
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------