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General NPI Number Information
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NPI Number | 1740283647
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ALLERGY IMMUNOLOGY ASSOC.,P.A.
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 7777 FOREST LANE SB332
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City | DALLAS
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State | TX
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Zip | 75230-6822
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Country | US
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Telephone | 972-566-7788
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Fax | 972-566-8837
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Provider Business Mailing Address
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Address Line | 7777 FOREST LN SUITE B332
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City | DALLAS
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State | TX
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Zip | 75230-2571
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Country | US
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Telephone | 972-566-7788
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Fax | 972-566-8837
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD L WASSERMAN
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Credential | M.D., PHD
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Telephone | 972-566-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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