Provider Demographics
NPI: | 1033418017 |
---|---|
Name: | ENDOCRINOLOGY OF NORTHERN TEXAS PLLC |
Entity Type: | Organization |
Organization Name: | ENDOCRINOLOGY OF NORTHERN TEXAS PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/ SOLE MEMBER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DUBEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 203-531-6586 |
Mailing Address - Street 1: | 5 EUREKA CIR |
Mailing Address - Street 2: | SUITE A |
Mailing Address - City: | WICHITA FALLS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76308-2900 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 203-531-6586 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5 EUREKA CIR |
Practice Address - Street 2: | SUITE A |
Practice Address - City: | WICHITA FALLS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76308-2900 |
Practice Address - Country: | US |
Practice Address - Phone: | 203-531-6586 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-03-16 |
Last Update Date: | 2012-08-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Single Specialty |