Provider Demographics
NPI:1457396905
Name:DCOA PHYSICIAN ASSOCIATES PA
Entity Type:Organization
Organization Name:DCOA PHYSICIAN ASSOCIATES PA
Other - Org Name:DIABETES AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF DCOA PA GROUP
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAJARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-402-8300
Mailing Address - Street 1:6420 N MACARTHUR BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2871
Mailing Address - Country:US
Mailing Address - Phone:972-402-8300
Mailing Address - Fax:972-373-0700
Practice Address - Street 1:6420 N MACARTHUR BLVD STE 130
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2871
Practice Address - Country:US
Practice Address - Phone:972-402-8300
Practice Address - Fax:972-373-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty