Provider Demographics
NPI:1144593294
Name:NORTH DALLAS DIGESTIVE DISEASE
Entity Type:Organization
Organization Name:NORTH DALLAS DIGESTIVE DISEASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:XINQING
Authorized Official - Middle Name:
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-929-9290
Mailing Address - Street 1:5821 BRAEMAR DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4731
Mailing Address - Country:US
Mailing Address - Phone:972-781-9030
Mailing Address - Fax:
Practice Address - Street 1:3509 SPECTRUM BLVD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-9703
Practice Address - Country:US
Practice Address - Phone:972-238-1858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2319261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty