Premier Gastroenterology of Texas PA

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

L0393 Issued in TX

Legal business name

PREMIER GASTROENTEROLOGY OF TEXAS PA

Practice address

7777 Forest Lane BLDG. C
Suite 204
Dallas, TX 75230-2513

Phone

(972) 566-5266

Fax

(972) 566-5245

NPI assigned

Nov 7, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Damien Bassam Mallat, M.D.NPI 1568421212

Title

President

Phone

(972) 566-5266

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Damien B Mallat, MD

  • Gastroenterology Physician
  • Dallas, TX
  • NPI 1568421212
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333324800000",
    "number": "1265719140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7777 FOREST LANE BLDG. C",
            "address_2": "SUITE 204",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302513",
            "telephone_number": "972-566-5266",
            "fax_number": "972-566-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 FOREST LANE BLDG. C",
            "address_2": "SUITE 204",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302513",
            "telephone_number": "972-566-5266",
            "fax_number": "972-566-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER GASTROENTEROLOGY OF TEXAS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-07",
        "last_updated": "2012-04-02",
        "status": "A",
        "authorized_official_last_name": "MALLAT",
        "authorized_official_first_name": "DAMIEN",
        "authorized_official_middle_name": "BASSAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-566-5266",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TX",
            "license": "L0393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Gastroenterology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.