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General NPI Number Information
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NPI Number | 1982026480
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Entity Type | Organization
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Legal Business Name | ALLERGY, ASTHMA & IMMUNOLOGY CENTER, PLLC
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Dates
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Enumeration Date | 01/17/2014
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 623 W FM 544 STE 104
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City | MURPHY
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State | TX
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Zip | 75094-4577
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Country | US
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Telephone | 972-521-3366
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Fax | 972-422-5656
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Provider Business Mailing Address
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Address Line | 6210 GEORGIAN CT
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City | DALLAS
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State | TX
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Zip | 75254-8652
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Country | US
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Telephone | 408-431-0256
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | SRIVIDYA SRIDHARA
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Credential | MD
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Telephone | 972-521-3366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | P4113
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License Number State | TX
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