Basic Information
| Provider Information | |||||||||
| NPI: | 1053709006 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA DOCTORS MANAGEMENT PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6505 W PARK BLVD | ||||||||
| Address2: | 306-292 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750936208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726687460 | ||||||||
| FaxNumber: | 9726687467 | ||||||||
| Practice Location | |||||||||
| Address1: | 6505 W PARK BLVD | ||||||||
| Address2: | 306-292 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750936208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726687460 | ||||||||
| FaxNumber: | 9726687467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2014 | ||||||||
| LastUpdateDate: | 12/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | PARKER | ||||||||
| AuthorizedOfficialFirstName: | DARVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2142070750 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.