Provider Demographics
NPI:1235112210
Name:PROSTATE SEED INSTITUTE
Entity Type:Organization
Organization Name:PROSTATE SEED INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-379-2700
Mailing Address - Street 1:PO BOX 650772
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0772
Mailing Address - Country:US
Mailing Address - Phone:214-379-2700
Mailing Address - Fax:214-379-2750
Practice Address - Street 1:7415 LAS COLINAS BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7568
Practice Address - Country:US
Practice Address - Phone:214-379-2700
Practice Address - Fax:214-379-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1676462Medicaid
TX1676462Medicaid