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General NPI Number Information
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NPI Number | 1417128505
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Entity Type | Organization
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Legal Business Name | DALLAS INSTITUTE OF ADVANCED MEDICINE INC.
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 2909 S HAMPTON RD SUITE F- 122, LOCK BOX 29
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City | DALLAS
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State | TX
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Zip | 75224-3000
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Country | US
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Telephone | 214-339-9350
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Fax | 214-331-9164
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Provider Business Mailing Address
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Address Line | DALLAS INSTITUTE OF ADVANCED MEDICINE INC6 P.O. BOX 9236
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City | DALLAS
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State | TX
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Zip | 75209-9236
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Country | US
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Telephone | 214-339-9350
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Fax | 214-331-9164
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWIN ESCOBAR-VAZQUEZ
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Credential | M.D.
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Telephone | 214-339-9350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | J1085
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License Number State | TX
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