Provider profile · NPI 1790179893
247 Obgyn Surgical Assisting Services
Physician Assistant, Surgical · Grand Prairie, TX · NPI 1790179893 · No federal exclusion match
✔ Verified against the public CMS NPPES registry & HHS-OIG LEIE as of Jun 21, 2026. Source-linked, daily-refreshed. Public data only — no PHI.
Registry details
Type
Organization
Primary specialty
Physician Assistant, Surgical
Enumerated
Mar 26, 2015
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 4924 MARSH HARRIER AVE | Grand Prairie, TX 75052-3057 | 972-652-0705 |
| LOCATION | 4924 MARSH HARRIER AVE | Grand Prairie, TX 75052-3057 | 972-652-0705 |
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