45D2085327 CLIA NUMBER - DALLAS - CARROLLTON OFFICE

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Laboratory Demographics

CLIA Number: 45D2085327

Facility Name: DALLAS - CARROLLTON OFFICE

Facility Address:
4323 NORTH JOSEY LANE SUITE 200
CARROLLTON, TX
ZIP 75010
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Facility Phone Number: 214 366-6113

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1790706067

Taxonomy: 207RG0100X - Internal Medicine
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.

CLIA Record

Field Name	Field Value
CLIA Number	45D2085327
LAB Type	Physician Office
Facility Name	DALLAS - CARROLLTON OFFICE
Street	4323 NORTH JOSEY LANE SUITE 200
City	CARROLLTON
State	TX
ZIP	75010
Phone	214 366-6113
CertificateType	4
CertificateEffectiveDate	10/10/2022
CertificateExpirationDate	10/9/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024