Organization
FUNCTIONAL IMAGING OF TEXAS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE R. SIMON M.D. (EXECUTIVE OFFICER)
(214) 435-2866
Entity
Organization
Contact information
Practice address
4851 S INTERSTATE 35 E, STE 101, CORINTH, TX 76210-2348
(972) 447-9799
Mailing address
PO BOX 650772, DALLAS, TX 75265-0772
(972) 447-9799
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0076MG
BC/BS
TX
01
—
DD9838
MEDICARE RAILROAD
TX
Enumeration date
07/30/2006
Last updated
08/22/2020
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