Organization
BREAST DIAGNOSTICS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRIYA R VENUGOPAL MD (PRESIDENT)
(817) 749-2000
Entity
Organization
Contact information
Practice address
1750 BROAD PARK CIR S, SUITE 300, MANSFIELD, TX 76063-7822
(817) 749-2000
(817) 749-2020
Mailing address
1545 E SOUTHLAKE BLVD, SUITE 200, SOUTHLAKE, TX 76092-6422
(817) 749-2000
(817) 749-2020
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M00778
TX
Other
Enumeration date
11/03/2009
Last updated
11/03/2009
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