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General NPI Number Information
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NPI Number | 1659777415
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Entity Type | Organization
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Legal Business Name | MEDICAL IMAGING OF GRAPEVINE
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 3801 WILLIAM D TATE AVE STE 800
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City | GRAPEVINE
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State | TX
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Zip | 76051-8755
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Country | US
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Telephone | 866-333-8443
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Fax | 866-316-0080
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Provider Business Mailing Address
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Address Line | 2140 E SOUTHLAKE BLVD STE L-426
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6516
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Country | US
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Telephone | 866-333-8443
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Fax | 866-316-0080
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAJESH GOGIA
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Credential |
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Telephone | 214-502-8157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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