| NPI | 1831468800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI R PHILLIP Practice Manager 972-722-3290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX K6483) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX J2983) |
| 208600000X Surgery (Licence: TX P6593) | |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2018-06-20 |