Provider Demographics
NPI:1790718484
Name:WHITE ROCK PULMONARY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:WHITE ROCK PULMONARY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-328-5487
Mailing Address - Street 1:9330 POPPY DRIVE
Mailing Address - Street 2:SUITE #407
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3403
Mailing Address - Country:US
Mailing Address - Phone:214-328-5487
Mailing Address - Fax:214-328-0419
Practice Address - Street 1:9330 POPPY DRIVE
Practice Address - Street 2:SUITE #407
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3403
Practice Address - Country:US
Practice Address - Phone:214-328-5487
Practice Address - Fax:214-328-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5758207RC0200X, 207RP1001X
207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079894401Medicaid
TX115596203Medicaid
TX00106NMedicare PIN
TX079894401Medicaid