Healthcare Provider Details

I. General information

NPI: 1538703525
Provider Name (Legal Business Name): PLANO PROFESSIONAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5316 W PLANO PKWY
PLANO TX
75093-4821
US

IV. Provider business mailing address

5960 W PARKER ROAD STE 278 - 415
PLANO TX
75093
US

V. Phone/Fax

Practice location:
  • Phone: 214-390-7697
  • Fax: 888-770-6360
Mailing address:
  • Phone: 214-390-7697
  • Fax: 888-770-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT WILCOX
Title or Position: ADMIN
Credential:
Phone: 214-390-7697