Provider Demographics
NPI:1316281975
Name:MD REQUEST PLLC
Entity type:Organization
Organization Name:MD REQUEST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTOREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-430-5850
Mailing Address - Street 1:4645 AVON LN STE 200
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1559
Mailing Address - Country:US
Mailing Address - Phone:469-430-5850
Mailing Address - Fax:877-722-7085
Practice Address - Street 1:4645 AVON LN STE 200
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1559
Practice Address - Country:US
Practice Address - Phone:469-430-5850
Practice Address - Fax:877-722-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX271221Medicare PIN