Provider Demographics
NPI:1629184999
Name:FERTILITY SPECIALISTS OF DALLAS, PA
Entity Type:Organization
Organization Name:FERTILITY SPECIALISTS OF DALLAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-750-5500
Mailing Address - Street 1:8315 WALNUT HILL LN
Mailing Address - Street 2:STE. 225
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4218
Mailing Address - Country:US
Mailing Address - Phone:214-750-5500
Mailing Address - Fax:214-750-5540
Practice Address - Street 1:8315 WALNUT HILL LN
Practice Address - Street 2:STE. 225
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4218
Practice Address - Country:US
Practice Address - Phone:214-750-5500
Practice Address - Fax:214-750-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4157174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0063MQOtherBLUE CROSS GROUP
TX0063MQOtherBLUE CROSS GROUP