Organization
PREMIER GASTROENTEROLOGY OF TEXAS PA
Active
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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