Provider Demographics
NPI:1255641213
Name:FERTILITY CENTER OF DALLAS
Entity type:Organization
Organization Name:FERTILITY CENTER OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GERNERAL PARTNER / MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-823-2692
Mailing Address - Street 1:3900 JUNIUS ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1615
Mailing Address - Country:US
Mailing Address - Phone:214-823-2692
Mailing Address - Fax:214-887-2844
Practice Address - Street 1:3900 JUNIUS ST
Practice Address - Street 2:SUITE 610
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1615
Practice Address - Country:US
Practice Address - Phone:214-823-2692
Practice Address - Fax:214-887-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory