Provider Demographics
NPI:1568469484
Name:PIN, PAUL GORDON
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GORDON
Last Name:PIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:STE 410
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1804
Mailing Address - Country:US
Mailing Address - Phone:214-827-2530
Mailing Address - Fax:214-826-6754
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:STE 410
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1804
Practice Address - Country:US
Practice Address - Phone:214-827-2530
Practice Address - Fax:214-826-6754
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5133208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE76945Medicare UPIN
TX00A37UMedicare ID - Type Unspecified