Provider Demographics
NPI:1619036845
Name:PEDIATRICIANS OF DALLAS, PA
Entity Type:Organization
Organization Name:PEDIATRICIANS OF DALLAS, PA
Other - Org Name:PEDIATRICIANS OF DALLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RYDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-691-3535
Mailing Address - Street 1:8325 WALNUT HILL LN
Mailing Address - Street 2:SUITE 225
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4208
Mailing Address - Country:US
Mailing Address - Phone:214-691-3535
Mailing Address - Fax:214-691-1044
Practice Address - Street 1:8325 WALNUT HILL LN
Practice Address - Street 2:SUITE 225
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4208
Practice Address - Country:US
Practice Address - Phone:214-691-3535
Practice Address - Fax:214-691-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care