| NPI | 1982257986 |
|---|---|
| Doing Business As | PRVIA MEDICIAL GROUP NORTH TEXAS |
| Entity Type | Organization |
| Authorized Contact | LARRY D TATUM C.E.O. 817-740-8400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 208000000X Pediatrics | |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2019-07-18 |