Provider Demographics
NPI:1750573184
Name:DAVID B. SEROTA, MD, PA
Entity type:Organization
Organization Name:DAVID B. SEROTA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUISNESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEROTA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:214-402-8106
Mailing Address - Street 1:PO BOX 670654
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75367-0654
Mailing Address - Country:US
Mailing Address - Phone:214-402-8106
Mailing Address - Fax:
Practice Address - Street 1:9440 POPPY DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3652
Practice Address - Country:US
Practice Address - Phone:214-402-8106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5493207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y804Medicare PIN