Provider Demographics
NPI:1053323204
Name:SEROLD, EMILY ARMOUR (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ARMOUR
Last Name:SEROLD
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:ARIZAGA
Other - Last Name:ARMOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:6038 ANITA ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5533
Mailing Address - Country:US
Mailing Address - Phone:214-887-1470
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-1847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03816363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282037501Medicaid
TX282037502Medicaid
TXTXB129106Medicare PIN
TX282037502Medicaid
TXTXB129104Medicare PIN