Provider Demographics
NPI:1124554746
Name:INTEGRATIVE MULTIDISCIPLINARY MEDICAL GROUP
Entity Type:Organization
Organization Name:INTEGRATIVE MULTIDISCIPLINARY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:EAST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-722-7102
Mailing Address - Street 1:670 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2733
Mailing Address - Country:US
Mailing Address - Phone:972-745-4446
Mailing Address - Fax:972-745-2597
Practice Address - Street 1:670 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2733
Practice Address - Country:US
Practice Address - Phone:972-745-4446
Practice Address - Fax:972-745-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty