=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508193251
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN P CHEEK MDPA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2009
-----------------------------------------------------
Last Update Date | 10/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8210 WALNUT HILL LN SUITE 516
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-369-6411
-----------------------------------------------------
Fax | 214-361-7102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8210 WALNUT HILL LN SUITE 516
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-369-6411
-----------------------------------------------------
Fax | 214-361-7102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INSURANCE COORDINATOR
-----------------------------------------------------
Name | MRS. LISA ANN DOMINGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-369-6411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | D3468
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------