Healthcare Provider Details

I. General information

NPI: 1821553454
Provider Name (Legal Business Name): LONESTAR WEIGHTLOSS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 TENNYSON PKWY STE 350
PLANO TX
75024-7249
US

IV. Provider business mailing address

415 PENDALL DR
WYLIE TX
75098-5564
US

V. Phone/Fax

Practice location:
  • Phone: 469-456-3303
  • Fax:
Mailing address:
  • Phone: 469-463-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK MICHAEL WHITFIELD
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 469-463-0070