Frisco Iom PA

NPI #1205369600 in Ft Worth, Texas

Provider Information

NPI Number: 1205369600
Entity Type: Organization
Organization Name: Frisco Iom PA
Primary Specialty: Electrodiagnostic Medicine
Enumeration Date: Apr 4, 2017
Last Updated: Apr 4, 2017

Practice Location

Address: 111 BOLAND ST STE 211
City: Ft Worth
State: Texas
ZIP Code: 76107-1265
Phone: (214) 269-3875

Authorized Official

Name: GINA SULLIVAN
Title: BILLING MANAGER
Phone: (214) 269-3875

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Electrodiagnostic Medicine	204R00000X	Primary

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