| Bruce E Whitehead, Md, Pa | |
|
12201 Merit Dr Suite 300 Dallas TX 75251-2213 | |
| (214) 294-8989 | |
| (214) 294-8977 |
| Full Name | Bruce E Whitehead, Md, Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 12201 Merit Dr, Dallas, Texas |
| Authorized Official Name and Position | Ivelisa Smith (PRACTICE MANAGER) |
| Authorized Official Contact | 2142948989 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bruce E Whitehead, Md, Pa 12201 Merit Dr Suite 300 Dallas TX 75251-2213 Ph: (214) 294-8989 | Bruce E Whitehead, Md, Pa 12201 Merit Dr Suite 300 Dallas TX 75251-2213 Ph: (214) 294-8989 |
| NPI Number | 1114300795 |
|---|---|
| Provider Enumeration Date | 07/01/2015 |
| Last Update Date | 01/14/2020 |
| Medicare PECOS PAC ID | 2365751799 |
|---|---|
| Medicare Enrollment ID | O20151026000191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114300795 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Bruce E Whitehead |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497796585 PECOS PAC ID: 4284658485 Enrollment ID: I20060113000800 |
| Provider Name | Megan Sarah Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104208990 PECOS PAC ID: 3476845884 Enrollment ID: I20160705001935 |
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