# THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** UT SOUTHWESTERN PHYSICAL MEDICINE AND REHABILITATION
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417099599
- **Authorized official:** BRUCE FAIRBANKS (VICE PRESIDENT)
- **Authorized official phone:** (214) 645-0624

## Contact information

- **Practice address:** 1000 S BECKHAM AVE, TYLER, TX 75701-1908
- **Practice address phone:** (214) 645-0624
- **Practice address fax:** (214) 645-0078
- **Mailing address:** PO BOX 854347, DALLAS, TX 75284-5347
- **Mailing address phone:** (214) 645-0624
- **Mailing address fax:** (214) 645-0078

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 08/22/2020