Healthcare Provider Details

I. General information

NPI: 1952874257
Provider Name (Legal Business Name): WEST PLANO SURGERY SPECIALIST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 N JOSEY LN
CARROLLTON TX
75010-4615
US

IV. Provider business mailing address

1141 N LOOP 1604 E # 105-612
SAN ANTONIO TX
78232-1339
US

V. Phone/Fax

Practice location:
  • Phone: 972-395-2220
  • Fax:
Mailing address:
  • Phone: 855-598-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SCHWARTZ
Title or Position: MANAGER
Credential:
Phone: 800-785-8765