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General NPI Number Information
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NPI Number | 1821692518
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Entity Type | Organization
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Legal Business Name | PRIMARY MD PLLC
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 2755 W 15TH ST
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City | PLANO
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State | TX
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Zip | 75075-7525
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Country | US
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Telephone | 469-642-4345
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Fax |
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Provider Business Mailing Address
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Address Line | 10605 LANSDOWNE LN
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City | ROWLETT
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State | TX
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Zip | 75089-8388
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Country | US
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Telephone | 469-642-4345
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDER M TANJUAKIO
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Credential |
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Telephone | 469-642-4345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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