Healthcare Provider Details

I. General information

NPI: 1275641896
Provider Name (Legal Business Name): CDG BARIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 ELDORADO PKWY SUITE 100
MCKINNEY TX
75070-4365
US

IV. Provider business mailing address

3001 HARDIN BLVD PMB #210 SUITE 110
MCKINNEY TX
75070-7489
US

V. Phone/Fax

Practice location:
  • Phone: 972-542-5122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA J STACIE
Title or Position: PRESIDENT
Credential:
Phone: 972-542-5122