Organization
GRAND PRAIRIE PHYSICIAN GROUP LLC
Active
Organization
GRAND PRAIRIE PHYSICIAN GROUP LLC
Active
Other names
GRAND PRAIRIE PHYSICIANS GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MIGUEL A DEL BOSQUE (CEO)
(469) 826-4294
Entity
Organization
Contact information
Practice address
517 N CARRIER PKWY STE J, GRAND PRAIRIE, TX 75050-5484
(214) 677-0639
(214) 677-0539
Mailing address
517 N CARRIER PKWY STE J, GRAND PRAIRIE, TX 75050-5484
(214) 677-0639
(214) 677-0539
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
Other
Enumeration date
02/27/2019
Last updated
04/22/2020
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