Organization
PRIME MD GERIATRICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIVYASWAPNIKA JAVVAJI (MANAGER)
(972) 393-1699
Entity
Organization
Contact information
Practice address
452 STATE HIGHWAY 121 UNIT 130, COPPELL, TX 75019-4275
(972) 393-1699
(972) 393-1702
Mailing address
452 STATE HIGHWAY 121 UNIT 130, COPPELL, TX 75019-4275
(972) 393-1699
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
03/07/2018
Last updated
06/07/2024
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