Organization
GENESIS RADIOLOGY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALBERT TESORIERO (MEDICAL DIRECTOR)
(972) 599-1860
Entity
Organization
Contact information
Practice address
2828 W PARKER RD, PLANO, TX 75075-9153
(972) 599-1860
Mailing address
PO BOX 864768, PLANO, TX 75086-4768
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G7011
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113724202
—
TX
05
—
1593231
—
LA
01
—
180974600
DEPT OF LABOR
TX
01
—
8J8280
BCBS
TX
Enumeration date
08/31/2006
Last updated
12/17/2008
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