=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467805887
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEORGE P. SHROPULOS, M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2016
-----------------------------------------------------
Last Update Date | 07/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4634 ROCKAWAY DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75214-2564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-534-3942
-----------------------------------------------------
Fax | 214-824-8820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4634 ROCKAWAY DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75214-2564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-824-8769
-----------------------------------------------------
Fax | 214-824-8820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D.
-----------------------------------------------------
Name | DR. GEORGE P. SHROPULOS
-----------------------------------------------------
Credential | C3202
-----------------------------------------------------
Telephone | 214-824-8769
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | C3202
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------