| NPI | 1629074893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLEN ELIZABETH FOURTON Director 972-860-8649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX 00T26W) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX 00T26W) |
| 207Q00000X Family Medicine (Licence: TX 00T26W) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2008-02-18 |