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NPI Code Detail

MEDICARE: DR. JAMES JOSEPH PETRIKAS SR. DO

MEDICARE:  DR. JAMES JOSEPH PETRIKAS SR. DO
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
12085R0001XRadiation Oncology Physician125-042933IL
22085R0001XRadiation Oncology PhysicianM4442TX

Other Identifiers

General Provider Information

NPI Number : 1356362719
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES JOSEPH PETRIKAS SR. DO
Provider Business Mailing Address
First Line : PO BOX 911230
Second Line :
City : DALLAS
State : TX
Zip : 75391-1230
Country : US
Telephone Number : 972-997-8000
Fax Number : 972-437-9605
Provider Business Practice Location Address
First Line : 4708 ALLIANCE BLVD STE 150
Second Line :
City : PLANO
State : TX
Zip : 75093-5339
Country : US
Telephone Number : 972-596-7801
Fax Number : 972-596-9307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 05/23/2019

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