Provider Demographics
NPI:1730308453
Name:BREAST SURGEONS OF NORTH TEXAS
Entity Type:Organization
Organization Name:BREAST SURGEONS OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-566-5872
Mailing Address - Street 1:7777 FOREST LN C614
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230
Mailing Address - Country:US
Mailing Address - Phone:972-566-5872
Mailing Address - Fax:972-566-6614
Practice Address - Street 1:7777 FOREST LN STE C614
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6856
Practice Address - Country:US
Practice Address - Phone:972-566-5872
Practice Address - Fax:972-566-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2651174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTID
TX=========OtherTID
TX00T94KMedicare ID - Type UnspecifiedGROUP ID