MEDICARE: PREVENTIVE MEDICINE CLINIC OF DALLAS

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	207Q00000X	Family Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1508085143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTIVE MEDICINE CLINIC OF DALLAS

Provider Business Mailing Address
First Line	:	2445 W NORTHWEST HWY STE 105
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4448
Country	:	US
Telephone Number	:	214-352-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 W NORTHWEST HWY STE 105
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4448
Country	:	US
Telephone Number	:	214-352-9600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HERIBERTO SALINAS
Credential	:	MD
Telephone Number	:	214-352-9600

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	09/17/2008

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