Healthcare Provider Details

I. General information

NPI: 1982982195
Provider Name (Legal Business Name): LONESTAR HOUSECALL PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 BROOKRIVER DR STE 303
DALLAS TX
75247-4055
US

IV. Provider business mailing address

8150 BROOKRIVER DR STE 303
DALLAS TX
75247-4055
US

V. Phone/Fax

Practice location:
  • Phone: 214-951-0009
  • Fax: 214-951-0060
Mailing address:
  • Phone: 214-951-0009
  • Fax: 214-951-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLUBAYO IDOWU
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 214-951-0009