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General NPI Number Information
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NPI Number | 1912248881
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Entity Type | Organization
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Legal Business Name | PRESTIGE PRIMARY CARE, P.A.
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Dates
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Enumeration Date | 03/02/2013
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 6029 BELT LINE RD STE 105
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City | DALLAS
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State | TX
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Zip | 75254-7873
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Country | US
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Telephone | 972-385-0000
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Fax | 972-385-1231
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Provider Business Mailing Address
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Address Line | 6029 BELT LINE RD STE 105
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City | DALLAS
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State | TX
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Zip | 75254-7873
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Country | US
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Telephone | 972-385-0000
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Fax | 972-385-1231
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ASIF AZIZ
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Credential | M.D.
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Telephone | 408-910-0840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N2391
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License Number State | TX
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