Provider Demographics
NPI:1568623619
Name:CHRIS M. VICENTE, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:CHRIS M. VICENTE, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:VICENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-707-3194
Mailing Address - Street 1:5702 ROWLETT RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-7925
Mailing Address - Country:US
Mailing Address - Phone:214-703-1900
Mailing Address - Fax:214-703-1901
Practice Address - Street 1:5702 ROWLETT RD STE 220
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-7925
Practice Address - Country:US
Practice Address - Phone:214-703-1900
Practice Address - Fax:214-703-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-21
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM34142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty