Provider Demographics
NPI:1417295353
Name:ALLERGY AND IMMUNOLOGY OF DALLAS
Entity Type:Organization
Organization Name:ALLERGY AND IMMUNOLOGY OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:NEAVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-661-9197
Mailing Address - Street 1:10 MEDICAL PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7845
Mailing Address - Country:US
Mailing Address - Phone:972-661-9197
Mailing Address - Fax:972-239-5526
Practice Address - Street 1:10 MEDICAL PKWY STE 204
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234
Practice Address - Country:US
Practice Address - Phone:972-243-7901
Practice Address - Fax:972-243-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX321859601Medicaid
TX321859602Medicaid