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Organization
PHYSICIAN ASSOCIATES OF SOUTHWEST DALLAS
Active
Organization
PHYSICIAN ASSOCIATES OF SOUTHWEST DALLAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL CULLISON MD (VICE PRESIDENT)
(214) 947-2356
Entity
Organization
Contact information
Practice address
122 W COLORADO BLVD, DALLAS, TX 75208-2382
(214) 947-6700
(214) 947-6701
Mailing address
3400 W WHEATLAND RD, BLDG III, SUITE 360, DALLAS, TX 75237-3460
(214) 884-4700
(214) 884-4761
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207VM0101X
Maternal & Fetal Medicine Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156122701
—
TX
01
—
156122702
MEDICAID TX HEALTH STEPS
TX
Enumeration date
05/09/2006
Last updated
12/13/2018
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