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Organization
UT SOUTHWESTERN MEDICAL CENTER
Active
Organization
UT SOUTHWESTERN MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WISAM NACHAWATI P.A. (PHYSICIAN ASSISTANT)
(972) 451-0617
Entity
Organization
Contact information
Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390-7201
(972) 451-0617
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(972) 451-0617
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
PA04785
TX
363A00000X
Physician Assistant
Primary
PA04785
TX
Other
Enumeration date
06/08/2008
Last updated
09/04/2013
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