Organization
DALLAS PEDIATRICS & INFECTIOUS DISEASE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARYAL ABDUL GHAFFAR MD (PRESIDENT)
(817) 416-5554
Entity
Organization
Contact information
Practice address
1120 S MAIN ST, SUITE 100, GRAPEVINE, TX 76051-5543
(817) 416-5554
(817) 416-5556
Mailing address
1120 S MAIN ST, SUITE 100, GRAPEVINE, TX 76051-5543
(817) 416-5554
(817) 416-5556
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
K9784
TX
2080P0208X
Pediatric Infectious Diseases Physician
K9784
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0088MQ
BLUE SHIELD
TX
05
—
175070501
—
TX
05
—
175070502
—
TX
Enumeration date
10/16/2007
Last updated
05/20/2016
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