Provider Demographics
NPI:1487726352
Name:DALLAS FAMILY MEDICINE, PA
Entity type:Organization
Organization Name:DALLAS FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-874-0205
Mailing Address - Street 1:824 LOWER DALLAS HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-9368
Mailing Address - Country:US
Mailing Address - Phone:704-874-0200
Mailing Address - Fax:704-874-0201
Practice Address - Street 1:824 LOWER DALLAS HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-9368
Practice Address - Country:US
Practice Address - Phone:704-874-0200
Practice Address - Fax:704-874-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2349334Medicare ID - Type Unspecified