MEDICARE: FARAH DADA PA-C

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	363AM0700X	Medical Physician Assistant	PA09353	TX

General Provider Information

NPI Number	:	1215336110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARAH DADA PA-C

Provider Business Mailing Address
First Line	:	4461 COIT RD
Second Line	:	SUITE 220
City	:	FRISCO
State	:	TX
Zip	:	75035-0521
Country	:	US
Telephone Number	:	972-377-9200
Fax Number	:	972-377-9300

Provider Business Practice Location Address
First Line	:	7150 PRESTON RD
Second Line	:	SUITE 300
City	:	PLANO
State	:	TX
Zip	:	75024-3279
Country	:	US
Telephone Number	:	972-705-9599
Fax Number	:	972-705-9590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	01/08/2015

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