Provider Demographics
NPI:1245696806
Name:DALLAS DIABETES AND ENDOCRINE CENTER
Entity type:Organization
Organization Name:DALLAS DIABETES AND ENDOCRINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SALOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:BANARER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-566-7799
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE C-685
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2571
Mailing Address - Country:US
Mailing Address - Phone:972-566-7799
Mailing Address - Fax:972-566-7399
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C-685
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-7799
Practice Address - Fax:972-566-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1490207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
612632OtherMEDICARE PTAN
612632OtherMEDICARE PTAN