Provider Demographics
NPI:1831200443
Name:DALLAS INTERNAL MEDICINE ASSOCIATES P.A.
Entity type:Organization
Organization Name:DALLAS INTERNAL MEDICINE ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-941-5200
Mailing Address - Street 1:221 W COLORADO BLVD STE 730
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2357
Mailing Address - Country:US
Mailing Address - Phone:214-941-5200
Mailing Address - Fax:214-948-8870
Practice Address - Street 1:221 W COLORADO BLVD STE 730
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2357
Practice Address - Country:US
Practice Address - Phone:214-941-5200
Practice Address - Fax:214-948-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000H19N8Medicaid
TXZ000H19N8Medicaid