Adolphus Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

N9413 Issued in TX

Legal business name

ADOLPHUS MEDICAL GROUP

Practice address

406 E Camp Wisdom Rd
Suite a
Dallas, TX 75241

Phone

(682) 478-9117

Fax

(817) 887-2305

NPI assigned

Aug 30, 2011

Organization subpart

No

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

Authorized official

Name

Grace Stanley, MD

Title

Director

Phone

(817) 614-9180

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314662400000",
    "number": "1447531876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 MCKINNEY AVE",
            "address_2": "SUITE 940",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752011908",
            "telephone_number": "682-478-9117",
            "fax_number": "817-887-2305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 E CAMP WISDOM RD",
            "address_2": "SUITE A",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75241",
            "telephone_number": "682-478-9117",
            "fax_number": "817-887-2305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADOLPHUS MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-30",
        "last_updated": "2011-08-30",
        "status": "A",
        "authorized_official_last_name": "STANLEY",
        "authorized_official_first_name": "GRACE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "817-614-9180",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N9413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.