Basic Information
| Provider Information | |||||||||
| NPI: | 1629188065 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH DALLAS DERMATOLOGY ASSOCIATES, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9301 N CENTRAL EXPY | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752310806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144207070 | ||||||||
| FaxNumber: | 2144207380 | ||||||||
| Practice Location | |||||||||
| Address1: | 9301 N CENTRAL EXPY | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752310806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144207070 | ||||||||
| FaxNumber: | 2144207380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 10/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | HURLEY | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2144207070 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | K5472 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.