MEDICARE: DORROUGH MEDICAL SERVICES PLLC

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	363L00000X	Nurse Practitioner
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1295499184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORROUGH MEDICAL SERVICES PLLC

Provider Business Mailing Address
First Line	:	1411 N BECKLEY AVE STE 356
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75203-1591
Country	:	US
Telephone Number	:	469-290-6400
Fax Number	:	469-290-6405

Provider Business Practice Location Address
First Line	:	1411 N BECKLEY AVE STE 356
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75203-1591
Country	:	US
Telephone Number	:	469-290-6400
Fax Number	:	469-290-6405

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MOLLIE RICE-DORROUGH
Credential	:	MD
Telephone Number	:	469-290-6400

Provider Enumeration Date	:	10/26/2021
Last Update Date	:	12/13/2022

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