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General NPI Number Information
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NPI Number | 1780179267
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Entity Type | Organization
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Legal Business Name | AVEO MEDICAL GROUP - NORTH TEXAS PLLC
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 8600 SKYLINE DR SUITE 1000
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City | DALLAS
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State | TX
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Zip | 75243
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Country | US
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Telephone | 214-695-1183
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Fax |
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Provider Business Mailing Address
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Address Line | 9041 MEADOWKNOLL DR
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City | DALLAS
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State | TX
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Zip | 75243-7518
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Country | US
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Telephone | 214-695-1183
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JORDAN PASTOREK
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Credential | MD
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Telephone | 337-255-7011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State | TX
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