Provider Demographics
NPI:1730569872
Name:QUAN DANG LE MD PA
Entity type:Organization
Organization Name:QUAN DANG LE MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-714-7577
Mailing Address - Street 1:1917 PARK AVE N
Mailing Address - Street 2:210
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-0884
Mailing Address - Country:US
Mailing Address - Phone:682-777-5211
Mailing Address - Fax:817-556-0148
Practice Address - Street 1:200 N CARRIER PKWY
Practice Address - Street 2:STE 101
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5476
Practice Address - Country:US
Practice Address - Phone:682-777-5211
Practice Address - Fax:817-556-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8048208100000X, 2081P2900X, 208VP0000X, 208VP0014X
LAMD203006208100000X, 2081P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005AAAOtherTX BCBS
TX00S5S5OtherGRP BCBS
TX005AAAOtherTX BCBS