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Organization

HEALTHTEXAS-MED PROVIDER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ELLEN ELIZABETH FOURTON (DIRECTOR)
(469) 800-8649
Entity
Organization

Contact information

Practice address
3417 GASTON AVE, SUITE 1000, DALLAS, TX 75246-2016
(469) 800-9000
(469) 800-9010
Mailing address
8080 N CENTRAL EXPY # LB82, STE 600, DALLAS, TX 75206-3794
(469) 800-8648
(469) 800-8679

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
00T27E
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0851826-02
TX
Enumeration date
06/20/2005
Last updated
04/20/2017
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