Organization
PREMIER GASTROENTEROLOGY OF TEXAS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAMIEN BASSAM MALLAT M.D. (PRESIDENT)
(972) 566-5266
Entity
Organization
Contact information
Practice address
7777 FOREST LANE BLDG. C, SUITE 204, DALLAS, TX 75230-2513
(972) 566-5266
(972) 566-5245
Mailing address
7777 FOREST LANE BLDG. C, SUITE 204, DALLAS, TX 75230-2513
(972) 566-5266
(972) 566-5245
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
L0393
TX
Other
Enumeration date
11/07/2011
Last updated
04/02/2012
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