Healthcare Provider Details

I. General information

NPI: 1538313002
Provider Name (Legal Business Name): FAMILY PRACTICE SPECIALISTS,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 W PARKER RD STE 225
PLANO TX
75093-8102
US

IV. Provider business mailing address

6300 W PARKER RD STE 225
PLANO TX
75093-8102
US

V. Phone/Fax

Practice location:
  • Phone: 972-981-7827
  • Fax: 972-981-7850
Mailing address:
  • Phone: 972-981-7827
  • Fax: 972-981-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberJ9262
License Number StateTX

VIII. Authorized Official

Name: SUSAN PAYBERAH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 972-981-7827