Basic Information
| Provider Information | |||||||||
| NPI: | 1114338175 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER DALLAS HEALTHCARE ENTERPRISES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 840711 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752840711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9153510699 | ||||||||
| FaxNumber: | 9155451660 | ||||||||
| Practice Location | |||||||||
| Address1: | 2311 N MESA ST | ||||||||
| Address2: | STE. G | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799023666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9153510699 | ||||||||
| FaxNumber: | 9155451660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2014 | ||||||||
| LastUpdateDate: | 06/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | BRANSTETTER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR DIR, ADMINISTR 501A, TENET | ||||||||
| AuthorizedOfficialTelephone: | 4698932000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.