Provider Demographics
NPI:1942682539
Name:ALLERGY AND ASTHMA CENTER OF DUNCANVILLE, PA
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA CENTER OF DUNCANVILLE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, OWNER, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PRESLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-345-1400
Mailing Address - Street 1:626 W WHEATLAND RD
Mailing Address - Street 2:STE B
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4587
Mailing Address - Country:US
Mailing Address - Phone:972-709-6673
Mailing Address - Fax:972-298-8590
Practice Address - Street 1:626 W WHEATLAND RD
Practice Address - Street 2:STE B
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4587
Practice Address - Country:US
Practice Address - Phone:972-709-6673
Practice Address - Fax:972-298-8590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH2615Other207K00000X