Provider Demographics
NPI:1235200064
Name:WHITE ROCK ADULT MEDICINE ASSOC PA
Entity Type:Organization
Organization Name:WHITE ROCK ADULT MEDICINE ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FITZHARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-321-6485
Mailing Address - Street 1:1130 BEACHVIEW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218
Mailing Address - Country:US
Mailing Address - Phone:214-321-6485
Mailing Address - Fax:214-324-3187
Practice Address - Street 1:1130 BEACHVIEW
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218
Practice Address - Country:US
Practice Address - Phone:214-321-6485
Practice Address - Fax:214-324-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084340101Medicaid