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General NPI Number Information
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NPI Number | 1780971549
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Entity Type | Organization
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Legal Business Name | UROLOGY CLINICS OF NORTH TEXAS, PLLC
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 1631 LANCASTER DR STE 350
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City | GRAPEVINE
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State | TX
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Zip | 76051-3599
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Country | US
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Telephone | 214-915-8502
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Fax | 682-223-5006
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Provider Business Mailing Address
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Address Line | 1650 REPUBLIC PKWY STE 130
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City | MESQUITE
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State | TX
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Zip | 75150-6920
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Country | US
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Telephone | 214-692-8262
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Fax | 214-696-4190
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Authorized Official
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Title or Position | CEO
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Name | JERRI D WILSON
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Credential |
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Telephone | 214-691-1902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | TX
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