Basic Information
| Provider Information | |||||||||
| NPI: | 1356362719 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETRIKAS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9724379605 | ||||||||
| Practice Location | |||||||||
| Address1: | 4708 ALLIANCE BLVD STE 150 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750935339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725967801 | ||||||||
| FaxNumber: | 9725969307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 05/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 125-042933 | IL | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | M4442 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 181896501 | 05 | TX | MEDICAID | 181896503 | 05 | TX | MEDICAID | 181896502 | 05 | TX | MEDICAID | 8W1133 | 01 | TX | BCBS | OTHER | 200123060A | 05 | OK | MEDICAID |