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General NPI Number Information
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NPI Number | 1295870152
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Entity Type | Organization
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Legal Business Name | LONE STAR GASTROENTEROLOGY, P.A.
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 4101 W SPRING CREEK PKWY SUITE 400
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City | PLANO
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State | TX
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Zip | 75024-5307
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Country | US
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Telephone | 972-867-7070
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Fax | 972-867-7878
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Provider Business Mailing Address
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Address Line | 4101 W SPRING CREEK PKWY SUITE 400
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City | PLANO
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State | TX
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Zip | 75024-5307
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Country | US
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Telephone | 972-867-7070
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Fax | 972-867-7878
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Authorized Official
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Title or Position | PRESIDENT
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Name | GOWRI BALACHANDAR
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Credential | MD
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Telephone | 972-867-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | K4363
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License Number State | TX
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