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Organization
SUNDANCE PHYSICAL MEDICINE PLLC
Active
Organization
SUNDANCE PHYSICAL MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GENNIE BUDET (CREDENTIALING DIRECTOR)
(702) 462-9729
Entity
Organization
Contact information
Practice address
1400 W 7TH ST STE 450, FORT WORTH, TX 76102-2601
(817) 935-8200
(817) 887-2052
Mailing address
3829 CATHEDRAL LAKE DR, FRISCO, TX 75034-3871
(337) 255-7011
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
09/14/2022
Last updated
10/19/2022
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