| Physician And Other Providers | |
|
5200 Harry Hines Blvd Dallas TX 75235-7709 | |
| (214) 590-8006 | |
| Not Available |
| Full Name | Physician And Other Providers |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 5200 Harry Hines Blvd, Dallas, Texas |
| Authorized Official Name and Position | Frederick P. Cerise (PRESIDENT/CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2145908006 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Physician And Other Providers Po Box 660599 Dallas TX 75266-0599 Ph: () - | Physician And Other Providers 5200 Harry Hines Blvd Dallas TX 75235-7709 Ph: (214) 590-8006 |
| NPI Number | 1649278995 |
|---|---|
| Provider Enumeration Date | 07/11/2005 |
| Last Update Date | 10/18/2024 |
| Certification Date | 10/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649278995 | NPI | - | NPPES |
| 082056501 | Medicaid | TX |
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