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General NPI Number Information
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NPI Number | 1043495575
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Entity Type | Organization
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Legal Business Name | HIGHLAND BARIATRIC CLINIC
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 2412 50TH ST SUITE 304
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City | LUBBOCK
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State | TX
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Zip | 79412-2504
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Country | US
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Telephone | 806-792-5552
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Fax | 806-792-5551
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Provider Business Mailing Address
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Address Line | 2412 50TH ST SUITE 304
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City | LUBBOCK
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State | TX
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Zip | 79412-2504
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Country | US
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Telephone | 806-792-5552
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Fax | 806-792-5551
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID S HALL
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Credential | M.D.
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Telephone | 806-792-5552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | E6396
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License Number State | TX
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