Provider Demographics
NPI:1336799618
Name:MEDICAL ASSOCIATES OF DALLAS PLLC
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES OF DALLAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GHOLAMREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSADOLLAH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:469-503-1916
Mailing Address - Street 1:PO BOX 794564
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-4564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4601 OLD SHEPARD PL STE 404
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5277
Practice Address - Country:US
Practice Address - Phone:972-964-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center