Provider Demographics
NPI:1952437584
Name:ENDOCRINOLOGY CLINIC OF NORTH TEXAS, P.A.
Entity Type:Organization
Organization Name:ENDOCRINOLOGY CLINIC OF NORTH TEXAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-547-7557
Mailing Address - Street 1:PO BOX 2486
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-2486
Mailing Address - Country:US
Mailing Address - Phone:972-991-9950
Mailing Address - Fax:972-991-4026
Practice Address - Street 1:1105 CENTRAL EXPY N
Practice Address - Street 2:SUITE 2360
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:214-547-7557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2344207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0031MYOtherFEDERAL BCBS
TX0031MYOtherBCBS
TX0031MYOtherFEDERAL BCBS
TX00622ZMedicare ID - Type UnspecifiedRAILROAD MEDICARE