Provider Demographics
NPI:1649222647
Name:OBSTETRICS & GYNECOLOGY PA
Entity Type:Organization
Organization Name:OBSTETRICS & GYNECOLOGY PA
Other - Org Name:OBSTETRICS & GYNECOLOGY PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-566-7009
Mailing Address - Street 1:7777 FOREST LN STE D550
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2557
Mailing Address - Country:US
Mailing Address - Phone:972-566-7009
Mailing Address - Fax:972-566-6289
Practice Address - Street 1:7777 FOREST LN STE D550
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2557
Practice Address - Country:US
Practice Address - Phone:972-566-7009
Practice Address - Fax:972-566-6289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8HF612OtherALL PLANS WITH ACCESS
TXH22311Medicare UPIN
TXC14521Medicare UPIN
TXB24916Medicare UPIN
TXI17352Medicare UPIN