Basic Information
Provider Information
NPI: 1790492734
EntityType: 2
ReplacementNPI:  
OrganizationName: JOHN KEVIN PAGE, MD, PLLC
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Mailing Information
Address1: 9330 LBJ FWY STE 800
Address2:  
City: DALLAS
State: TX
PostalCode: 752434310
CountryCode: US
TelephoneNumber: 9727925700
FaxNumber: 2145061170
Practice Location
Address1: 1631 LANCASTER DR STE 330
Address2:  
City: GRAPEVINE
State: TX
PostalCode: 760513585
CountryCode: US
TelephoneNumber: 9727925700
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/31/2022
LastUpdateDate: 10/31/2022
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AuthorizedOfficialLastName: PAGE
AuthorizedOfficialFirstName: JOHN
AuthorizedOfficialMiddleName: KEVIN
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 8173669772
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate: 10/31/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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