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General NPI Number Information
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NPI Number | 1639574403
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Entity Type | Organization
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Legal Business Name | ENDOCRINOLOGY AND DIABETES SPECIALIST PA
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 11970 N CENTRAL EXPY SUITE 630
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City | DALLAS
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State | TX
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Zip | 75243-3768
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Country | US
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Telephone | 972-998-6711
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Fax | 972-421-1677
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Provider Business Mailing Address
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Address Line | 11970 N CENTRAL EXPY SUITE 630
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City | DALLAS
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State | TX
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Zip | 75243-3768
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Country | US
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Telephone | 972-998-6711
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Fax | 972-421-1677
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. MARYAM ZAMANIAN
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Credential | M.D.
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Telephone | 972-998-6711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | M0612
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License Number State | TX
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