Healthcare Provider Details

I. General information

NPI: 1851586994
Provider Name (Legal Business Name): PARK LANE ALLERGY AND ASTHMA CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 N CENTRAL EXPY 430
DALLAS TX
75231-5927
US

IV. Provider business mailing address

9101 N CENTRAL EXPY 430
DALLAS TX
75231-5927
US

V. Phone/Fax

Practice location:
  • Phone: 214-363-8889
  • Fax: 214-363-9416
Mailing address:
  • Phone: 214-363-8889
  • Fax: 214-363-9416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberL4312
License Number StateTX

VIII. Authorized Official

Name: DR. STEVEN COLE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 214-363-8889