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NPI Code Detail

MEDICARE: DR. JONATHAN MOSES PRIEGO MD

MEDICARE: DR. JONATHAN MOSES PRIEGO MD
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
1208000000XPediatrics PhysicianU6326TX
2390200000XStudent in an Organized Health Care Education/Training ProgramTX
32080P0204XPediatric Emergency Medicine (Pediatrics) PhysicianU6326TX

General Provider Information

NPI Number : 1255836706
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN MOSES PRIEGO MD
Provider Business Mailing Address
First Line : 7777 FOREST LN STE C840
Second Line :
City : DALLAS
State : TX
Zip : 75230-2594
Country : US
Telephone Number : 915-540-5355
Fax Number :
Provider Business Practice Location Address
First Line : 7777 FOREST LN STE C840
Second Line :
City : DALLAS
State : TX
Zip : 75230-2594
Country : US
Telephone Number : 915-540-5355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2018
Last Update Date : 01/11/2024

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