NPIMap

Organization Active NPI

Liberty Medical Diagnostics Center

  • Neurology Physician
  • Dallas, TX
National Provider Identifier
1649674474
Registry record updated Mar 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
LIBERTY MEDICAL DIAGNOSTICS CENTER
Practice address
14850 Montfort Dr
Suite 181, LB 11
Dallas, TX 75254-7077
Phone
(202) 271-0205
NPI assigned
Oct 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2017

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

Authorized official

Name
Dustin Ray, M.D.
Title
Manager
Phone
(214) 396-7725

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Hand Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0106X TX
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X TX
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X TX Primary
Other Specialist/TechnologistGroup: 193200000X MULTI-SPECIALTY GROUP 246Z00000X

Addresses

Primary practice location

14850 Montfort Dr
Suite 181, LB 11
Dallas, TX 75254-7077

Mailing address

14850 Montfort Dr
Suite 181, LB 11
Dallas, TX 75254-7077
Phone (202) 271-0205

National Provider Directory

National Provider Directory
Tax ID family
Liberty Medical Diagnostics Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488412800000",
    "number": "1649674474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14850 MONTFORT DR",
            "address_2": "SUITE 181, LB 11",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752547077",
            "telephone_number": "202-271-0205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14850 MONTFORT DR",
            "address_2": "SUITE 181, LB 11",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752547077",
            "telephone_number": "202-271-0205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY MEDICAL DIAGNOSTICS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-22",
        "last_updated": "2017-03-02",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "214-396-7725",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XS0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TX",
            "license": null,
            "primary": true
        },
        {
            "code": "246Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Other",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2017; 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.