Provider Demographics
NPI:1033418017
Name:ENDOCRINOLOGY OF NORTHERN TEXAS PLLC
Entity type:Organization
Organization Name:ENDOCRINOLOGY OF NORTHERN TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-531-6586
Mailing Address - Street 1:5 EUREKA CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2900
Mailing Address - Country:US
Mailing Address - Phone:203-531-6586
Mailing Address - Fax:
Practice Address - Street 1:5 EUREKA CIR
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2900
Practice Address - Country:US
Practice Address - Phone:203-531-6586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2012-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty