Provider Demographics
NPI:1164722401
Name:NORTH DALLAS UROGYNECOLOGY, PLLC
Entity Type:Organization
Organization Name:NORTH DALLAS UROGYNECOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:LE
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-234-8888
Mailing Address - Street 1:3140 LEGACY DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6008
Mailing Address - Country:US
Mailing Address - Phone:469-234-8888
Mailing Address - Fax:469-234-8894
Practice Address - Street 1:3140 LEGACY DR
Practice Address - Street 2:SUITE 210
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6008
Practice Address - Country:US
Practice Address - Phone:469-234-8888
Practice Address - Fax:469-234-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5283207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN5283OtherMEDICAL LICENSE