Organization
TEXAS PREMIUM MEDICAL LLC
Active
Other names
Texas Premium Medical LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHESTER J DONNALLY III MD (MANAGER)
(214) 370-3535
Entity
Organization
Contact information
Practice address
4643 WESTGROVE DR, ADDISON, TX 75001-3216
(214) 370-3535
(469) 248-0083
Mailing address
17051 DALLAS PKWY STE 400, ADDISON, TX 75001-7108
(214) 370-3535
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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