Provider Demographics
NPI:1356521512
Name:L D ANESTHESIA, P.A.
Entity type:Organization
Organization Name:L D ANESTHESIA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DULLYE
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:214-370-0790
Mailing Address - Street 1:PO BOX 720395
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75372-0395
Mailing Address - Country:US
Mailing Address - Phone:469-438-8053
Mailing Address - Fax:972-690-7857
Practice Address - Street 1:621 N HALL ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1339
Practice Address - Country:US
Practice Address - Phone:214-820-3151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0007GHOtherBCBS TEXAS
TX8A7510OtherBCBS TX
TX8A7510OtherBCBS TX
TX0007GHOtherBCBS TEXAS