Provider Demographics
NPI:1386079267
Name:OTOLARYNGOLOGY SPECIALISTS OF NORTH TEXAS PA
Entity type:Organization
Organization Name:OTOLARYNGOLOGY SPECIALISTS OF NORTH TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-378-0633
Mailing Address - Street 1:6300 W PARKER RD
Mailing Address - Street 2:SUITE 326
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8100
Mailing Address - Country:US
Mailing Address - Phone:972-378-0633
Mailing Address - Fax:972-278-0656
Practice Address - Street 1:6300 W PARKER RD
Practice Address - Street 2:SUITE 326
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8100
Practice Address - Country:US
Practice Address - Phone:972-378-0633
Practice Address - Fax:972-278-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3577 H8358174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty