Provider Demographics
NPI:1750349577
Name:FAMILY MEDICAL ASSOC. OF NORTH DALLAS, PA
Entity type:Organization
Organization Name:FAMILY MEDICAL ASSOC. OF NORTH DALLAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-358-0090
Mailing Address - Street 1:9991 MARSH LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-1766
Mailing Address - Country:US
Mailing Address - Phone:214-358-0090
Mailing Address - Fax:214-526-6851
Practice Address - Street 1:9991 MARSH LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-1766
Practice Address - Country:US
Practice Address - Phone:214-358-0090
Practice Address - Fax:214-526-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091900302Medicaid
TX91900303Medicaid
TX091900302Medicaid