Organization
CCST ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA J MANGRAM M.D. (TRAUMA SURGEON)
(214) 943-8605
Entity
Organization
Contact information
Practice address
221 W COLORADO BLVD, SUITE 100, DALLAS, TX 75208
(214) 943-8605
(214) 941-3076
Mailing address
221 W COLORADO BLVD, SUITE 100, DALLAS, TX 75208
(214) 943-8605
(214) 941-3076
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J8654
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144729404
—
TX
Enumeration date
09/22/2006
Last updated
10/17/2007
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