Provider Demographics
NPI:1851638217
Name:DALLAS VASCULAR GROUP, P.L.L.C
Entity Type:Organization
Organization Name:DALLAS VASCULAR GROUP, P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-345-4160
Mailing Address - Street 1:8210 WALNUT HILL LN STE 505
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4420
Mailing Address - Country:US
Mailing Address - Phone:214-345-4160
Mailing Address - Fax:214-345-4165
Practice Address - Street 1:8210 WALNUT HILL LN STE 505
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4420
Practice Address - Country:US
Practice Address - Phone:214-345-4160
Practice Address - Fax:214-345-4165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty