Provider Demographics
NPI:1558517672
Name:PARAGON AMBULATORY HEALTH RESOURCES, LLC
Entity Type:Organization
Organization Name:PARAGON AMBULATORY HEALTH RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-450-8704
Mailing Address - Street 1:5600 W LOVERS LN # 116-349
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-4330
Mailing Address - Country:US
Mailing Address - Phone:903-450-8704
Mailing Address - Fax:903-450-8997
Practice Address - Street 1:5600 W LOVERS LN # 116-349
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-4330
Practice Address - Country:US
Practice Address - Phone:903-450-8704
Practice Address - Fax:903-450-8997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical