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General NPI Number Information
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NPI Number | 1225332042
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Entity Type | Organization
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Legal Business Name | US TOXICOLOGY LLC
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Dates
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Enumeration Date | 01/09/2011
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Last Update Date | 01/09/2011
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Provider Practice Location Address
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Address Line | 13601 PRESTON RD SUITE 220
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City | DALLAS
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State | TX
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Zip | 75240-4911
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Country | US
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Telephone | 972-386-6399
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Fax | 972-386-6603
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Provider Business Mailing Address
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Address Line | PO BOX 731369
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City | DALLAS
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State | TX
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Zip | 75373-0001
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Country | US
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Telephone | 972-386-6399
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Fax | 972-386-6603
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. JEFFREY LAWRENCE WASSERMAN
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Credential | MD
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Telephone | 214-886-2108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 45D2016335
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License Number State | TX
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