Provider Demographics
NPI:1407451750
Name:PATHOLOGISTS BIO-MEDICAL LABORATORIES PLLC
Entity Type:Organization
Organization Name:PATHOLOGISTS BIO-MEDICAL LABORATORIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DYSERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-818-9122
Mailing Address - Street 1:3600 GASTON AVE STE 261
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1902
Mailing Address - Country:US
Mailing Address - Phone:972-966-7877
Mailing Address - Fax:
Practice Address - Street 1:3365 E QUAD PARK CT STE 103
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5905
Practice Address - Country:US
Practice Address - Phone:210-386-0053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty