# PRIMARY MD PLLC

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

## Provider details

- **NPI number:** 1821692518
- **Authorized official:** ALEXANDER M TANJUAKIO (OWNER)
- **Authorized official phone:** (469) 642-4345

## Contact information

- **Practice address:** 2755 W 15TH ST, PLANO, TX 75075-7525
- **Practice address phone:** (469) 642-4345
- **Mailing address:** 10605 LANSDOWNE LN, ROWLETT, TX 75089-8388
- **Mailing address phone:** (469) 642-4345

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/24/2020
- **Last updated:** 12/01/2020