Basic Information
| Provider Information | |||||||||
| NPI: | 1396843215 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BACKLAS & ASSOCIATES LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 52236 | ||||||||
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| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785052236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565810303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2121 E GRIFFIN PKWY | ||||||||
| Address2: | 12 | ||||||||
| City: | MISSION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785723241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565810303 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 12/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | BACKLAS | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9565810303 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | D74108 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.