Provider Demographics
NPI:1174082150
Name:CMDPN MEDICAL GROUP OF TEXAS, P.A.
Entity type:Organization
Organization Name:CMDPN MEDICAL GROUP OF TEXAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-215-4554
Mailing Address - Street 1:3838 OAK LAWN AVE, SUITE 1000
Mailing Address - Street 2:PMB 1123
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3838 OAK LAWN AVE, SUITE 1000
Practice Address - Street 2:PMB 1123
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219
Practice Address - Country:US
Practice Address - Phone:720-996-0522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty