Provider Demographics
NPI:1922010818
Name:DALLAS E & W OB/GYN CLINIC, P.A.
Entity Type:Organization
Organization Name:DALLAS E & W OB/GYN CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:WENLIANG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-378-9666
Mailing Address - Street 1:3100 MIDWAY RD
Mailing Address - Street 2:SUITE 169
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8471
Mailing Address - Country:US
Mailing Address - Phone:972-378-9666
Mailing Address - Fax:972-378-9888
Practice Address - Street 1:3100 MIDWAY RD
Practice Address - Street 2:SUITE 169
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8471
Practice Address - Country:US
Practice Address - Phone:972-378-9666
Practice Address - Fax:972-378-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A0803OtherMEDICARE INDIVIDUAL PIN
TX00361UMedicare PIN