Organization
HEALTHTEXAS PROVIDER NETWORK--DALLAS DIAGNOSTIC ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN ELIZABETH FOURTON (DIRECTOR)
(972) 860-8649
Entity
Organization
Contact information
Practice address
601 CLARA BARTON BLVD, STE 300, GARLAND, TX 75042-5755
(972) 494-6235
(972) 272-2073
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
Primary
00R87R
TX
207R00000X
Internal Medicine Physician
00R87R
TX
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
00R87R
TX
207RG0100X
Gastroenterology Physician
00R87R
TX
207RP1001X
Pulmonary Disease Physician
00R87R
TX
207RR0500X
Rheumatology Physician
00R87R
TX
2084N0400X
Neurology Physician
00R87R
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00R87R
BCBS
TX
05
—
0849374-01
—
TX
Enumeration date
06/23/2005
Last updated
04/22/2010
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