Provider Demographics
NPI:1659041093
Name:IDELL PSYCHIATRY
Entity Type:Organization
Organization Name:IDELL PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:IDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-709-1961
Mailing Address - Street 1:3500 OAK LAWN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4349
Mailing Address - Country:US
Mailing Address - Phone:972-709-1961
Mailing Address - Fax:972-283-1689
Practice Address - Street 1:3500 OAK LAWN AVE STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4349
Practice Address - Country:US
Practice Address - Phone:972-709-1961
Practice Address - Fax:972-283-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty