Provider Demographics
NPI:1659327773
Name:NORTHWEST DALLAS FAMILY MEDICAL ASSOCIATION, P.A.
Entity Type:Organization
Organization Name:NORTHWEST DALLAS FAMILY MEDICAL ASSOCIATION, P.A.
Other - Org Name:PATIENT PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-333-7333
Mailing Address - Street 1:3464 WEBB CHAPEL EXT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-6751
Mailing Address - Country:US
Mailing Address - Phone:214-528-4053
Mailing Address - Fax:214-528-4056
Practice Address - Street 1:3464 WEBB CHAPEL EXT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-6751
Practice Address - Country:US
Practice Address - Phone:214-528-4053
Practice Address - Fax:214-528-4056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130084003Medicaid
TX00621NMedicare ID - Type Unspecified