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General NPI Number Information
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NPI Number | 1124531686
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Entity Type | Organization
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Legal Business Name | LAGDOB MEDICAL, PLLC
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 5600 W LOVERS LN STE 116 284
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City | DALLAS
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State | TX
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Zip | 75209-4360
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Country | US
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Telephone | 469-754-0993
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 W LOVERS LN STE 116 284
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City | DALLAS
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State | TX
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Zip | 75209-4360
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Country | US
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Telephone | 469-754-0993
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Fax |
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Authorized Official
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Title or Position | MDMS NPI COMPLIANCE OFFICER
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Name | LIZETTE MORIN
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Credential |
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Telephone | 210-598-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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