Organization
HEALTHTEXAS PROVIDER NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN ELIZABETH FOURTON (DIRECTOR)
(972) 860-8649
Entity
Organization
Contact information
Practice address
4708 ALLIANCE BLVD, STE 270, PLANO, TX 75093-5337
(214) 826-6276
(214) 826-6223
Mailing address
8080 N CENTRAL EXPY, STE 600, LB82, DALLAS, TX 75206-1838
(972) 860-8648
(972) 860-8679
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
00363X
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1688814-01
—
TX
Enumeration date
06/20/2005
Last updated
09/11/2013
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