Provider Demographics
NPI:1629258058
Name:DALLAS GERIATRICS ASSOCIATES, P.A
Entity Type:Organization
Organization Name:DALLAS GERIATRICS ASSOCIATES, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTSNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-900-0747
Mailing Address - Street 1:445 E. FM 1382
Mailing Address - Street 2:SUITE # 3354
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104
Mailing Address - Country:US
Mailing Address - Phone:972-900-0747
Mailing Address - Fax:972-393-5234
Practice Address - Street 1:4200 SHEPHERD LN
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-3423
Practice Address - Country:US
Practice Address - Phone:214-325-1969
Practice Address - Fax:972-291-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6213207QG0300X
207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y540OtherGROUP PTAN/ DALLAS COUNTY
TXH75575OtherMEDICARE UPIN
TXL5100OtherTEXAS MEDICAL LICENSE #
TX00Y542OtherGROUP PTAN/ TARRANT COUNTY
TX00Y541OtherGROUP PTAN/ ELLIS & TARRANT COUNTY