=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053347534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARREN WAYNE LACKAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2006
-----------------------------------------------------
Last Update Date | 09/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6844 HARRIS PKWY STE 300
-----------------------------------------------------
City | FT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76132-4281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-263-0007
-----------------------------------------------------
Fax | 817-263-1118
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6844 HARRIS PKWY STE 300
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76132-4281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-263-0007
-----------------------------------------------------
Fax | 817-263-1118
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | L6481
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | L6481
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------