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General NPI Number Information
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NPI Number | 1609897727
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Entity Type | Organization
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Legal Business Name | NORTH DALLAS EAR, NOSE, AND THROAT PA
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 2821 E PRESIDENT GEORGE BUSH HWY SUITE 509
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City | RICHARDSON
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State | TX
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Zip | 75082-4266
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Country | US
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Telephone | 972-480-8877
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 25887
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City | OKLAHOMA CITY
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State | OK
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Zip | 73125-0887
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MORRIS GOTTLIEB
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Credential |
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Telephone | 972-480-8877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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