Organization
PREMIER DIABETES ENDOCRINOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TED OBIALO (MANAGER)
(972) 492-9901
Entity
Organization
Contact information
Practice address
4100 FAIRWAY DR STE 620, CARROLLTON, TX 75010-6539
(972) 492-9901
(972) 492-9902
Mailing address
PO BOX 378, COPPELL, TX 75019-0378
(972) 492-9901
(972) 492-9902
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0011LM
BCBS
TX
05
—
167630601
—
TX
Enumeration date
12/27/2006
Last updated
04/08/2011
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