Healthcare Provider Details

I. General information

NPI: 1104144377
Provider Name (Legal Business Name): THE CENTRE FOR REPRODUCTIVE MEDICINE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 22ND ST SUITE 300
LUBBOCK TX
79410-1347
US

IV. Provider business mailing address

3405 22ND ST SUITE 300
LUBBOCK TX
79410-1347
US

V. Phone/Fax

Practice location:
  • Phone: 806-788-1212
  • Fax: 806-788-1253
Mailing address:
  • Phone: 806-788-1212
  • Fax: 806-788-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberF9899
License Number StateTX

VIII. Authorized Official

Name: JANELLE DORSETT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 806-788-1212