Provider Demographics
NPI:1750521639
Name:THYROID,ENDOCRINOLOGY AND DIABETES, PA
Entity type:Organization
Organization Name:THYROID,ENDOCRINOLOGY AND DIABETES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:VINCENT ESTOY
Authorized Official - Last Name:FORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-693-3871
Mailing Address - Street 1:1018 N ZANG BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4123
Mailing Address - Country:US
Mailing Address - Phone:214-412-2160
Mailing Address - Fax:972-427-5151
Practice Address - Street 1:1018 N ZANG BLVD STE 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4123
Practice Address - Country:US
Practice Address - Phone:214-412-2160
Practice Address - Fax:972-427-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3223207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A4623Medicare PIN