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General NPI Number Information
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NPI Number | 1487077111
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Entity Type | Organization
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Legal Business Name | PHYCARE SERVICES INC
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Dates
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Enumeration Date | 01/31/2014
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Last Update Date | 01/31/2014
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Provider Practice Location Address
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Address Line | 2201 MAIN ST 1225
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City | DALLAS
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State | TX
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Zip | 75201-4327
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Country | US
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Telephone | 817-526-2882
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 MAIN ST 1225
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City | DALLAS
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State | TX
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Zip | 75201-4327
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ROOSEVELT GILMORE I
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Credential |
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Telephone | 817-526-2882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G37993
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License Number State | TX
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