Provider Demographics
NPI:1720098379
Name:INTERNAL MEDICINE ASSOCIATES OF DALLAS
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-827-7600
Mailing Address - Street 1:3600 GASTON AVE STE 1004
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1810
Mailing Address - Country:US
Mailing Address - Phone:214-827-7600
Mailing Address - Fax:214-827-0076
Practice Address - Street 1:3600 GASTON AVE STE 1004
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1810
Practice Address - Country:US
Practice Address - Phone:214-827-7600
Practice Address - Fax:214-827-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P601Medicare ID - Type Unspecified