Organization
PREFERRED SURGICAL ASSOCIATES OF TEXAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHNNY RAY STATON LSA (DIRECTOR)
(214) 980-9437
Entity
Organization
Contact information
Practice address
1208 PAINTBRUSH ST, MESQUITE, TX 75149-2634
(214) 227-2457
(214) 764-0880
Mailing address
PO BOX 938, ROWLETT, TX 75030-0938
(214) 227-2457
(214) 764-0880
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922530591
—
TX
Enumeration date
01/08/2018
Last updated
04/25/2019
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