Provider Demographics
NPI:1548358906
Name:BULLDOG RADIOLOGY PLLC
Entity type:Organization
Organization Name:BULLDOG RADIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:832-472-3301
Mailing Address - Street 1:PO BOX 202027
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0001
Mailing Address - Country:US
Mailing Address - Phone:866-594-0329
Mailing Address - Fax:
Practice Address - Street 1:1717 HIGHWAY 59 LOOP N
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-5703
Practice Address - Country:US
Practice Address - Phone:936-329-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003PDOtherBCBS GROUP NUMBER
TX0003PDOtherBCBS GROUP NUMBER