Organization
LIBERTY MEDICAL DIAGNOSTICS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUSTIN RAY M.D. (MANAGER)
(214) 396-7725
Entity
Organization
Contact information
Practice address
14850 MONTFORT DR, SUITE 181, LB 11, DALLAS, TX 75254-7077
(202) 271-0205
Mailing address
14850 MONTFORT DR, SUITE 181, LB 11, DALLAS, TX 75254-7077
(202) 271-0205
Taxonomy
Speciality
Code
Description
License number
State
207XS0106X
Orthopaedic Hand Surgery Physician
—
TX
208100000X
Physical Medicine & Rehabilitation Physician
—
TX
2084N0400X
Neurology Physician
Primary
—
TX
246Z00000X
Other Specialist/Technologist
—
—
Other
Enumeration date
10/22/2014
Last updated
03/02/2017
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