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General NPI Number Information
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NPI Number | 1558658245
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Entity Type | Organization
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Legal Business Name | NORTH TEXAS FAMILY CARE ASSOCIATES PA
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 823 IRA E WOODS AVE SUITE 200
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City | GRAPEVINE
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State | TX
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Zip | 76051-4083
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Country | US
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Telephone | 817-421-9999
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Fax | 817-421-9910
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Provider Business Mailing Address
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Address Line | PO BOX 2166
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City | GRAPEVINE
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State | TX
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Zip | 76099-2166
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Country | US
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Telephone | 817-421-9999
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Fax | 817-421-9910
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Authorized Official
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Title or Position | PRESIDENT
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Name | SABA SHABNAM
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Credential | M.D.
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Telephone | 817-421-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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