Provider Demographics
NPI:1912327776
Name:LIBERTY SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:LIBERTY SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-315-6432
Mailing Address - Street 1:6900 N DALLAS PKWY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7144
Mailing Address - Country:US
Mailing Address - Phone:214-396-7725
Mailing Address - Fax:214-396-7725
Practice Address - Street 1:6900 N DALLAS PKWY
Practice Address - Street 2:SUITE 800
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7144
Practice Address - Country:US
Practice Address - Phone:214-396-7725
Practice Address - Fax:214-396-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty