Provider Demographics
NPI:1083861298
Name:PARAGON AMBULATORY PHYSICIAN SERVICES, PA
Entity Type:Organization
Organization Name:PARAGON AMBULATORY PHYSICIAN SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:N
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-450-8704
Mailing Address - Street 1:11700 PRESTON RD # 660-560
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6112
Mailing Address - Country:US
Mailing Address - Phone:903-450-8704
Mailing Address - Fax:903-450-8997
Practice Address - Street 1:11700 PRESTON RD # 660-560
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6112
Practice Address - Country:US
Practice Address - Phone:903-450-8704
Practice Address - Fax:903-450-8997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty