MEDICARE: DOCTORS OF INTERNAL MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	618212	TX

General Provider Information

NPI Number	:	1073776993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS OF INTERNAL MEDICINE

Provider Business Mailing Address
First Line	:	3545 HIGH VISTA DR
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-6054
Country	:	US
Telephone Number	:	214-662-0210
Fax Number	:

Provider Business Practice Location Address
First Line	:	5941 DALLAS PKWY STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-9002
Country	:	US
Telephone Number	:	972-785-4455
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	KAREN MARIE CROWDER
Credential	:	NP
Telephone Number	:	972-785-4455

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	07/10/2008

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