Healthcare Provider Details

I. General information

NPI: 1679922256
Provider Name (Legal Business Name): ERNESTO MANUEL LLANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD
DALLAS TX
75390-9151
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-7208
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-3985
  • Fax:
Mailing address:
  • Phone: 214-633-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberU7003
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: