Organization
FUNCTIONAL IMAGING OF TEXAS, PA
Active
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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