=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891113338
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAR, NOSE, THROAT & ALLERGY CLINIC OF DALLAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2014
-----------------------------------------------------
Last Update Date | 04/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5952 ROYAL LN STE 120
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230-7847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-691-7546
-----------------------------------------------------
Fax | 214-234-0053
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5952 ROYAL LN STE 120
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230-7847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-691-7546
-----------------------------------------------------
Fax | 214-234-0053
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. REYNALDO CARLOS SANCHEZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 214-691-7546
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0602X
-----------------------------------------------------
Taxonomy Name | Otolaryngic Allergy Physician
-----------------------------------------------------
License Number | E2838
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | E2838
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------