Provider Demographics
NPI:1235797994
Name:AMD MEDICAL PLLC
Entity Type:Organization
Organization Name:AMD MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORTILUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-424-9523
Mailing Address - Street 1:3500 HILLCREST DR STE 7
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3144
Mailing Address - Country:US
Mailing Address - Phone:254-424-9523
Mailing Address - Fax:254-424-9846
Practice Address - Street 1:3500 HILLCREST DR STE 7
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3144
Practice Address - Country:US
Practice Address - Phone:254-424-9523
Practice Address - Fax:254-424-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty