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General NPI Number Information
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NPI Number | 1902061278
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Entity Type | Organization
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Legal Business Name | EXCEL PERFORMANCE MEDICAL CENTER
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Dates
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Enumeration Date | 07/25/2008
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 5550 LBJ FWY SUITE 360
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City | DALLAS
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State | TX
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Zip | 75240-6217
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Country | US
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Telephone | 972-996-0906
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Fax | 972-996-0905
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Provider Business Mailing Address
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Address Line | 5550 LBJ FWY SUITE 360
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City | DALLAS
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State | TX
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Zip | 75240-6217
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Country | US
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Telephone | 972-996-0906
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Fax | 972-996-0905
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLOTTE BURNS
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Credential | O.D., M.S., J.D.,
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Telephone | 972-996-0906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | C8197
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License Number State | TX
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