Provider Demographics
NPI:1386722833
Name:OB-GYN PLACE, A PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:OB-GYN PLACE, A PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEWELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-772-3234
Mailing Address - Street 1:901 ROCKWALL PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6502
Mailing Address - Country:US
Mailing Address - Phone:972-772-3234
Mailing Address - Fax:972-772-3834
Practice Address - Street 1:901 ROCKWALL PKWY
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6502
Practice Address - Country:US
Practice Address - Phone:972-772-3234
Practice Address - Fax:972-772-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T30WMedicare ID - Type Unspecified