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General NPI Number Information
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NPI Number | 1750708061
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Entity Type | Organization
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Legal Business Name | BOSTON MEDICAL GROUP - TEXAS, P.A.
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 12801 N CENTRAL EXPY STE 1107
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City | DALLAS
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State | TX
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Zip | 75243-1893
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Country | US
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Telephone | 469-374-0439
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Fax | 469-374-0629
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Provider Business Mailing Address
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Address Line | 12801 N CENTRAL EXPY STE 1107
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City | DALLAS
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State | TX
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Zip | 75243-1893
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Country | US
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Telephone | 469-374-0439
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Fax | 469-374-0629
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOAN SIMPSON
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Credential |
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Telephone | 615-562-4048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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