Provider Demographics
NPI:1689222945
Name:PHOENIX INTEGRATIVE MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:PHOENIX INTEGRATIVE MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-616-0234
Mailing Address - Street 1:6380 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6384
Mailing Address - Country:US
Mailing Address - Phone:214-616-0234
Mailing Address - Fax:
Practice Address - Street 1:6380 PRESTON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6384
Practice Address - Country:US
Practice Address - Phone:214-616-0234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty