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General NPI Number Information
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NPI Number | 1497864490
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Entity Type | Organization
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Legal Business Name | ALLAN S. DISRAELI, M.D., P.A.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 333 N SHILOH RD SUITE 105
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City | GARLAND
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State | TX
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Zip | 75042-6680
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Country | US
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Telephone | 972-272-5458
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Fax |
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Provider Business Mailing Address
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Address Line | 333 N SHILOH RD SUITE 105
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City | GARLAND
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State | TX
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Zip | 75042-6680
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Country | US
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Telephone | 972-272-5458
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Fax |
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Authorized Official
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Title or Position | PRESIDEMT
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Name | DR. ALLAN S. DISRAELI
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Credential | M.D.
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Telephone | 972-272-5458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | D3853
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License Number State | TX
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