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NPI Code Detail

MEDICARE: TEXAS VASCULAR ASSOCIATES

MEDICARE: TEXAS VASCULAR ASSOCIATES
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
1335E00000XProsthetic/Orthotic SupplierTX
22086S0129XVascular Surgery PhysicianTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194718429
Entity Type Code : Organization
Provider Name (Legal Business Name) : TEXAS VASCULAR ASSOCIATES
Provider Business Mailing Address
First Line : 621 N HALL ST
Second Line : SUITE 100
City : DALLAS
State : TX
Zip : 75226-1339
Country : US
Telephone Number : 214-821-9600
Fax Number : 214-823-5449
Provider Business Practice Location Address
First Line : 621 N. HALL ST.
Second Line : SUITE 100
City : DALLAS
State : TX
Zip : 75226-1339
Country : US
Telephone Number : 214-821-9600
Fax Number : 214-823-5449
Authorized Official
Title or Position : VASCULAR SURGEON
Name : DR. GREGORY J PEARL
Credential : MD
Telephone Number : 214-821-9600
Provider Enumeration Date : 08/23/2005
Last Update Date : 05/15/2015

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Directions to “TEXAS VASCULAR ASSOCIATES ” Practice Location

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