Provider Demographics
NPI:1255933016
Name:MDLAB
Entity type:Organization
Organization Name:MDLAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-708-6641
Mailing Address - Street 1:3001 KNOX ST STE 303
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-7304
Mailing Address - Country:US
Mailing Address - Phone:972-688-6330
Mailing Address - Fax:
Practice Address - Street 1:3001 KNOX ST STE 303
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-7304
Practice Address - Country:US
Practice Address - Phone:972-688-6330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty