Provider Demographics
NPI:1811083702
Name:INFECTIOUS DISEASE DOCTORS, PA
Entity type:Organization
Organization Name:INFECTIOUS DISEASE DOCTORS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-484-7700
Mailing Address - Street 1:PO BOX 802772
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75380-2772
Mailing Address - Country:US
Mailing Address - Phone:972-484-7700
Mailing Address - Fax:972-484-7718
Practice Address - Street 1:6537 PRESTON RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2610
Practice Address - Country:US
Practice Address - Phone:972-484-7700
Practice Address - Fax:469-729-6743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146907401Medicaid
TX146907401Medicaid