MEDICARE: DFW FAMILY CLINIC - IRVING INC

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	363LF0000X	Family Nurse Practitioner
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1538737275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DFW FAMILY CLINIC - IRVING INC

Provider Business Mailing Address
First Line	:	3501 N MACARTHUR BLVD STE 330
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-3611
Country	:	US
Telephone Number	:	972-887-3376
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 N MACARTHUR BLVD STE 330
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-3611
Country	:	US
Telephone Number	:	972-887-3376
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADILA SIDDIQI
Credential	:
Telephone Number	:	817-714-5300

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	06/17/2021

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