# PREMIER DIABETES ENDOCRINOLOGY, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275698532
- **Authorized official:** MR. TED OBIALO (MANAGER)
- **Authorized official phone:** (972) 492-9901

## Contact information

- **Practice address:** 4100 FAIRWAY DR STE 620, CARROLLTON, TX 75010-6539
- **Practice address phone:** (972) 492-9901
- **Practice address fax:** (972) 492-9902
- **Mailing address:** PO BOX 378, COPPELL, TX 75019-0378
- **Mailing address phone:** (972) 492-9901
- **Mailing address fax:** (972) 492-9902

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/27/2006
- **Last updated:** 04/08/2011