Basic Information
| Provider Information | |||||||||
| NPI: | 1215024476 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH TEXAS INFECTIOUS DISEASES CONSULTANTS, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26303 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731260303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142765656 | ||||||||
| FaxNumber: | 2143703316 | ||||||||
| Practice Location | |||||||||
| Address1: | 6124 WEST PARKER ROAD | ||||||||
| Address2: | SUITE 436 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750938125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726081009 | ||||||||
| FaxNumber: | 9729813333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2006 | ||||||||
| LastUpdateDate: | 03/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | SLOAN | ||||||||
| AuthorizedOfficialFirstName: | LOUIS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2148232533 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.