=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497463616
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAYTWO PHYSICIAN SERVICES, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2022
-----------------------------------------------------
Last Update Date | 11/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1999 BRYAN ST STE 900
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75201-3140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-999-6100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 CADILLAC DR STE 350
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-5094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ATTORNEY
-----------------------------------------------------
Name | WAHIDA BHUYAN
-----------------------------------------------------
Credential | ESQ.
-----------------------------------------------------
Telephone | 516-650-8891
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------