Provider Demographics
NPI:1619399706
Name:NEUROLOGICAL ASSOCIATES OF NORTH TEXAS
Entity Type:Organization
Organization Name:NEUROLOGICAL ASSOCIATES OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-404-0993
Mailing Address - Street 1:9330 POPPY DR
Mailing Address - Street 2:500B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4621
Mailing Address - Country:US
Mailing Address - Phone:214-404-0993
Mailing Address - Fax:
Practice Address - Street 1:9330 POPPY DR
Practice Address - Street 2:500B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4621
Practice Address - Country:US
Practice Address - Phone:214-404-0993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6687207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
330723Medicare PIN