Healthcare Provider Details

I. General information

NPI: 1871639757
Provider Name (Legal Business Name): DARREN LACKAN M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6844 HARRIS PARKWAY
FT. WORTH TX
76132
US

IV. Provider business mailing address

6844 HARRIS PKWY STE 300
FORT WORTH TX
76132-4281
US

V. Phone/Fax

Practice location:
  • Phone: 817-263-0007
  • Fax: 817-263-1118
Mailing address:
  • Phone: 817-263-0007
  • Fax: 817-263-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberL6481
License Number StateTX

VIII. Authorized Official

Name: DARREN WAYNE LACKAN
Title or Position: OWNER
Credential: MD
Phone: 682-225-1157