Provider Demographics
NPI:1215207642
Name:NORTH TEXAS MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:NORTH TEXAS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DANHOF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-264-7676
Mailing Address - Street 1:222 SW 2ND ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1770
Mailing Address - Country:US
Mailing Address - Phone:972-264-7676
Mailing Address - Fax:972-263-1059
Practice Address - Street 1:222 SW 2ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1770
Practice Address - Country:US
Practice Address - Phone:972-264-7676
Practice Address - Fax:972-263-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-02
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0103207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty