Provider Demographics
NPI:1003077561
Name:JOHN A. DEMOPULOS, M.D., P.A.
Entity Type:Organization
Organization Name:JOHN A. DEMOPULOS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMOPULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:972-566-8380
Mailing Address - Street 1:7777 FOREST LN STE B216
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6810
Mailing Address - Country:US
Mailing Address - Phone:972-566-8380
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN STE B216
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6810
Practice Address - Country:US
Practice Address - Phone:972-566-8380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8543207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1233587-04Medicaid
TX00J11EOtherMEDICARE ID
TX00J11EOtherMEDICARE ID