Healthcare Provider Details

I. General information

NPI: 1497440408
Provider Name (Legal Business Name): WEST TEXAS ALLERGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 19TH ST STE 300
LUBBOCK TX
79407-2164
US

IV. Provider business mailing address

5000 BRIARWOOD AVE STE 100
MIDLAND TX
79707-2753
US

V. Phone/Fax

Practice location:
  • Phone: 806-795-4391
  • Fax: 806-796-1354
Mailing address:
  • Phone: 432-682-5385
  • Fax: 432-682-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PATRICK WOLBERT
Title or Position: OWNER/PHYSICIAN
Credential:
Phone: 432-682-5385