Provider Demographics
NPI:1174729503
Name:NORTH DALLAS INTERNAL MEDICINE
Entity type:Organization
Organization Name:NORTH DALLAS INTERNAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-696-1118
Mailing Address - Street 1:8210 WALNUT HILL LANE STE 416
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-696-1118
Mailing Address - Fax:
Practice Address - Street 1:8210 WALNUT HILL LANE STE 416
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-696-1118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8725207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00741RMedicare ID - Type Unspecified
TXC19364Medicare UPIN