Organization
MEDICAL & SURGICAL CLINIC OF IRVING, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFRY MICHAEL DUKE (EXECUTIVE DIRECTOR)
(972) 253-4286
Entity
Organization
Contact information
Practice address
6750 N MACARTHUR BLVD, SUITE 255, IRVING, TX 75039-2875
(972) 253-2560
Mailing address
2021 N MACARTHUR BLVD, SUITE 150, IRVING, TX 75061-2219
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M5102
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T158
MEDICARE GROUP PTAN
TX
Enumeration date
06/27/2016
Last updated
06/27/2016
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