MEDICARE: SPECIALISTS IN GERIATRIC AND PALLIATIVE CARE MEDICINE 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	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M7859	OTHER	TX	TEXAS MEDICAL LICENSE

General Provider Information

NPI Number	:	1659987022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALISTS IN GERIATRIC AND PALLIATIVE CARE MEDICINE PLLC

Provider Business Mailing Address
First Line	:	8198 WALNUT HILL LANE
Second Line	:	JACKSON BLDG SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8210 WALNUT HILL LN STE 310
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4419
Country	:	US
Telephone Number	:	972-913-2850
Fax Number	:	972-913-2975

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TAZEEN AKBAR
Credential	:
Telephone Number	:	469-854-3546

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	09/23/2022

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