Provider Demographics
NPI:1689861080
Name:NORTH DALLAS PRIMARY CARE P.A
Entity Type:Organization
Organization Name:NORTH DALLAS PRIMARY CARE P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-235-2304
Mailing Address - Street 1:2100 N COLLINS BLVD
Mailing Address - Street 2:MEDICAL PLAZA 3, #315
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2661
Mailing Address - Country:US
Mailing Address - Phone:972-235-2304
Mailing Address - Fax:972-235-8442
Practice Address - Street 1:2100 N COLLINS BLVD
Practice Address - Street 2:MEDICAL PLAZA 3, #315
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2661
Practice Address - Country:US
Practice Address - Phone:972-235-2304
Practice Address - Fax:972-235-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00694RMedicare PIN