Organization
HEALTHTEXAS PROVIDER NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN ELIZABETH FOURTON (DIRECTOR)
(972) 860-8649
Entity
Organization
Contact information
Practice address
3600 GASTON AVE, SUITE 1101, DALLAS, TX 75246-1800
(214) 820-7010
(214) 820-7015
Mailing address
8080 N CENTRAL EXPY, SUITE 600, LB82, DALLAS, TX 75206-1838
(972) 860-8648
(972) 860-8679
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
00955K
TX
207T00000X
Neurological Surgery Physician
00955K
TX
207X00000X
Orthopaedic Surgery Physician
Primary
00955K
TX
207XX0801X
Orthopaedic Trauma Physician
00955K
TX
207Y00000X
Otolaryngology Physician
00955K
TX
2084N0400X
Neurology Physician
00955K
TX
2085R0001X
Radiation Oncology Physician
00955K
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0077DJ
BCBS
TX
05
—
0814253-02
—
TX
Enumeration date
07/14/2005
Last updated
08/04/2011
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