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General NPI Number Information
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NPI Number | 1659577138
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Entity Type | Organization
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Legal Business Name | DAPHNE L FAVROTH MD AND ASSOCIATES
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 551 N PLANO RD
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City | RICHARDSON
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State | TX
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Zip | 75081-2940
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Country | US
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Telephone | 972-669-8400
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Fax | 972-235-0033
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Provider Business Mailing Address
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Address Line | 551 N PLANO RD
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City | RICHARDSON
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State | TX
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Zip | 75081-2940
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Country | US
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Telephone | 972-669-8400
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Fax | 972-235-0033
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAPHNE LOUISE FAVROTH
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Credential | MD
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Telephone | 972-669-8400
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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 | 019205
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | H9074
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 019205
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | H9074
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License Number State | TX
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