Individual
DALLAS BROADWAY
Active
Individual
DALLAS BROADWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
191294
NY
2085R0202X
Diagnostic Radiology Physician
Primary
249640
NY
2085R0202X
Diagnostic Radiology Physician
ME135979
FL
2085R0204X
Vascular & Interventional Radiology Physician
P8223
TX
261QA1903X
Ambulatory Surgical Clinic/Center
249640
NY
261QA1903X
Ambulatory Surgical Clinic/Center
25MA09187400
NJ
Other
Enumeration date
06/13/2007
Last updated
08/25/2026
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