Provider Demographics
NPI:1992570436
Name:XPRESSDOC DFW PLLC
Entity type:Organization
Organization Name:XPRESSDOC DFW PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUSOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-813-9632
Mailing Address - Street 1:5473 BLAIR ROAD
Mailing Address - Street 2:SUITE 100, PMB 912463
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4101
Mailing Address - Country:US
Mailing Address - Phone:773-742-8780
Mailing Address - Fax:
Practice Address - Street 1:12400 DALLAS PARKWAY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4227
Practice Address - Country:US
Practice Address - Phone:214-813-9632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty