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General NPI Number Information
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NPI Number | 1518936475
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Entity Type | Organization
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Legal Business Name | PEDIATRIC HEMATOLOGY ONCOLOGY OF NORTH TEXAS
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7777 FOREST LANE SUITE B-311
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City | DALLAS
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State | TX
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Zip | 75230
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Country | US
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Telephone | 972-566-8870
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Fax | 972-566-8817
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Provider Business Mailing Address
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Address Line | 7777 FOREST LANE SUITE B-311
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City | DALLAS
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State | TX
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Zip | 75230
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Country | US
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Telephone | 972-566-8870
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Fax | 972-566-8817
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Authorized Official
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Title or Position | MD
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Name | MR. AMMAR B MORAD
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Credential | MD
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Telephone | 972-566-8870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | J3720
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License Number State | TX
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