Provider Demographics
NPI:1164899639
Name:PERIOPERATIVE AND TRANSITIONAL MEDICINE GROUP PLLC
Entity Type:Organization
Organization Name:PERIOPERATIVE AND TRANSITIONAL MEDICINE GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LONE
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:214-238-3074
Mailing Address - Street 1:2108 DALLAS PKWY
Mailing Address - Street 2:SUITE 214-566
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8210 WALNUT HILL LN
Practice Address - Street 2:SUITE 312
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4405
Practice Address - Country:US
Practice Address - Phone:214-238-3074
Practice Address - Fax:214-238-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM4304OtherLICENSE #
TX154232OtherUPIN
TX351460601Medicaid
TX439636Medicare UPIN