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General NPI Number Information
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NPI Number | 1619659760
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Entity Type | Organization
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Legal Business Name | IMG MEDICAL GROUP TX, P.A.
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 325 N SAINT PAUL ST STE 3100
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City | DALLAS
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State | TX
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Zip | 75201-3923
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Country | US
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Telephone | 888-760-4266
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Fax |
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Provider Business Mailing Address
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Address Line | 201 BROAD ST STE 420
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City | STAMFORD
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State | CT
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Zip | 06901-2004
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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 | ROBERT REFOWITZ
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Credential | MD
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Telephone | 888-760-4266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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