Provider Demographics
NPI:1306003017
Name:NORTH DFW UROLOGY LLP
Entity Type:Organization
Organization Name:NORTH DFW UROLOGY LLP
Other - Org Name:NORTH DFW IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-328-7727
Mailing Address - Street 1:1601 LANCASTER DR STE 170
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-2110
Mailing Address - Country:US
Mailing Address - Phone:817-481-7727
Mailing Address - Fax:817-329-0077
Practice Address - Street 1:1601 LANCASTER DR STE 170
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2110
Practice Address - Country:US
Practice Address - Phone:817-481-7727
Practice Address - Fax:817-329-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty