Provider Demographics
NPI:1710205349
Name:DALLAS, JOHN GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GREGORY
Last Name:DALLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7033 N FRESNO ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2976
Mailing Address - Country:US
Mailing Address - Phone:559-435-5581
Mailing Address - Fax:559-435-5583
Practice Address - Street 1:7033 N FRESNO ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2976
Practice Address - Country:US
Practice Address - Phone:559-435-5581
Practice Address - Fax:559-435-5583
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG28788173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine