Provider Demographics
NPI:1154745479
Name:PREMIUM CHOICE HEALTH CARE, P.A.
Entity type:Organization
Organization Name:PREMIUM CHOICE HEALTH CARE, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:MAUL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-501-1410
Mailing Address - Street 1:3140 BOURBON STREET CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5415
Mailing Address - Country:US
Mailing Address - Phone:214-577-3876
Mailing Address - Fax:214-501-1411
Practice Address - Street 1:5700 ROWLETT RD
Practice Address - Street 2:SUITE 140
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-7922
Practice Address - Country:US
Practice Address - Phone:214-501-1410
Practice Address - Fax:214-501-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty