| NPI | 1528063146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLEN ELIZABETH FOURTON Director 972-860-8649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX 0079BV) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX 0079BV) |
| 207R00000X Internal Medicine (Licence: TX 0079BV) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2010-01-20 |