Organization
DALLAS COUNTY HOSPITAL DISTRICT
Active
Other names
Southeast Dallas Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK P. CERISE M.D. (PRESIDENT & CHIEF EXECUTIVE OFFICER)
(214) 590-8006
Entity
Organization
Contact information
Practice address
9202 ELAM RD, DALLAS, TX 75217-4151
(214) 266-1600
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
(214) 590-4105
(214) 590-4162
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080011201
—
TX
05
—
080011202
—
TX
05
—
133247006
—
TX
Enumeration date
06/30/2006
Last updated
12/07/2022
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