Organization
INDUSTRIAL MED MANAGEMENT OF HALTOM CITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARLA GREGG (CREDENTIALING COORDINATOR)
(972) 991-9950
Entity
Organization
Contact information
Practice address
3145 DENTON HWY, HALTOM CITY, TX 76117-3710
(817) 831-0999
(817) 831-2228
Mailing address
PO BOX 2486, ADDISON, TX 75001-2486
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12345
12345
TX
Enumeration date
10/23/2007
Last updated
10/23/2007
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