Provider Demographics
NPI:1194751107
Name:BOTTS, JOHN T (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:BOTTS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:17480 DALLAS PKWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7337
Mailing Address - Country:US
Mailing Address - Phone:972-488-8926
Mailing Address - Fax:972-881-4390
Practice Address - Street 1:17480 DALLAS PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7337
Practice Address - Country:US
Practice Address - Phone:972-488-8926
Practice Address - Fax:972-881-4390
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2014-06-17
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Provider Licenses
StateLicense IDTaxonomies
TXK7508207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00146VMedicare PIN
TX8A6551Medicare PIN
TX8A6552Medicare PIN
TX00147VMedicare PIN