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General NPI Number Information
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NPI Number | 1083911622
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Entity Type | Organization
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Legal Business Name | LITTLE ELM FRISCO CHILDREN'S CLINIC
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 12398 FM 423 SUITE 600
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City | FRISCO
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State | TX
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Zip | 75033-0158
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Country | US
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Telephone | 214-494-4622
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Fax | 214-494-4609
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Provider Business Mailing Address
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Address Line | 12398 FM 423 SUITE 600
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City | FRISCO
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State | TX
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Zip | 75033-0158
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Country | US
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Telephone | 214-494-4622
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Fax | 214-494-4609
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Authorized Official
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Title or Position | PARTNER
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Name | DR. PREM P GUPTA
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Credential | MD
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Telephone | 214-494-4622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | F8878
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | F7772
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License Number State | TX
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