Provider Demographics
NPI:1699169078
Name:INFECTIOUSCARE, PA
Entity type:Organization
Organization Name:INFECTIOUSCARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:BRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-588-1050
Mailing Address - Street 1:PO BOX 794165
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-4165
Mailing Address - Country:US
Mailing Address - Phone:214-691-8306
Mailing Address - Fax:214-691-3967
Practice Address - Street 1:8230 WALNUT HILL LN
Practice Address - Street 2:PB III, SUITE 308B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4482
Practice Address - Country:US
Practice Address - Phone:214-691-8306
Practice Address - Fax:214-691-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty