Organization
HEALTHTEXAS-DALLAS DIAGNOSTIC ASSOCIATION
Active
Other names
Dallas Diagnostic Association
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN ELIZABETH FOURTON (DIRECTOR)
(972) 860-8649
Entity
Organization
Contact information
Practice address
4708 ALLIANCE BLVD, STE 300, PLANO, TX 75093-5339
(972) 758-6000
(972) 758-6001
Mailing address
8080 N CENTRAL EXPY, STE 600, LB82, DALLAS, TX 75206-1838
(972) 860-8648
(972) 860-8679
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
00845W
TX
207R00000X
Internal Medicine Physician
Primary
00845W
TX
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
00845W
TX
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
00845W
TX
207RG0100X
Gastroenterology Physician
00845W
TX
207RP1001X
Pulmonary Disease Physician
00845W
TX
207RR0500X
Rheumatology Physician
00845W
TX
2084N0400X
Neurology Physician
00845W
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00R87R
BCBS
TX
05
—
1678278-01
—
TX
Enumeration date
06/20/2005
Last updated
06/11/2010
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