Provider Demographics
NPI:1558737122
Name:PEGASUS CLINIC, PLLC
Entity Type:Organization
Organization Name:PEGASUS CLINIC, PLLC
Other - Org Name:PEGASUS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-422-0633
Mailing Address - Street 1:6120 SWISS AVE UNIT 140326
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-0050
Mailing Address - Country:US
Mailing Address - Phone:512-422-0633
Mailing Address - Fax:214-980-0650
Practice Address - Street 1:6060 NORTH CENTRAL EXPRESSWAY
Practice Address - Street 2:SUITE 424
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214
Practice Address - Country:US
Practice Address - Phone:512-422-0633
Practice Address - Fax:214-980-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty