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General NPI Number Information
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NPI Number | 1043720154
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Entity Type | Organization
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Legal Business Name | HEALTHCARE ASSOCIATES OF SOUTHLAKE LLP
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 2106 E STATE HIGHWAY 114 STE 300
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City | SOUTHLAKE
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State | TX
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Zip | 76092
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Country | US
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Telephone | 817-552-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 2106 E STATE HIGHWAY 114 STE 300
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City | SOUTHLAKE
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State | TX
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Zip | 76092
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Country | US
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Telephone | 817-552-4300
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/PARTNER
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Name | WALTER GAMAN
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Credential | MD
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Telephone | 817-307-9312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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