Provider Demographics
NPI:1508074113
Name:WHITE ROCK INTERNAL MEDICINE
Entity Type:Organization
Organization Name:WHITE ROCK INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-328-4389
Mailing Address - Street 1:9330 POPPY DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4621
Mailing Address - Country:US
Mailing Address - Phone:214-328-4389
Mailing Address - Fax:214-328-4085
Practice Address - Street 1:9330 POPPY DR
Practice Address - Street 2:SUITE 403
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4621
Practice Address - Country:US
Practice Address - Phone:214-328-4389
Practice Address - Fax:214-328-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1134288012OtherNPI
TX1134288012OtherNPI
TX00A42WMedicare PIN