Provider Demographics
NPI:1326379173
Name:PLAZA MEDICAL SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:PLAZA MEDICAL SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-852-1550
Mailing Address - Street 1:301 CLIFFORD CENTER DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4443
Mailing Address - Country:US
Mailing Address - Phone:817-737-6552
Mailing Address - Fax:817-732-6597
Practice Address - Street 1:301 CLIFFORD CENTER DR
Practice Address - Street 2:SUITE 115
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4443
Practice Address - Country:US
Practice Address - Phone:817-737-6552
Practice Address - Fax:817-732-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty