Individual
JELIX AMBATTU THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3500 GASTON AVE, DALLAS, TX 75246-2017
(214) 820-0111
Mailing address
3500 GASTON AVE, DALLAS, TX 75246-2017
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
T0017
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
429707901
—
TX
Enumeration date
04/01/2019
Last updated
05/17/2024
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