=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477835254
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALEX MOMPOINT MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2011
-----------------------------------------------------
Last Update Date | 11/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3839 MCKINNEY AVE STE 155-256
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75204-1413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-658-3459
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3839 MCKINNEY AVE STE 155-256
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75204-1413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-658-3459
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALEX MOMPOINT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 402-658-3459
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------