Organization
DALLAS COUNTY HOSPITAL DISTRICT
Active
Other names
Pediatric Primary Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
FREDRICK P. CERISE M.D. (PRESIDENT & CHIEF EXECUTIVE OFFICER)
(214) 590-8006
Entity
Organization
Contact information
Practice address
5151 MAPLE AVE # 6B, DALLAS, TX 75235-8136
(214) 266-0110
(214) 266-0113
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111924001
—
TX
05
—
111924002
—
TX
05
—
133247005
—
TX
Enumeration date
06/04/2006
Last updated
07/10/2023
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