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General NPI Number Information
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NPI Number | 1306507504
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE CARDIOLOGY PLLC
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 3341 UNICORN LAKE BLVD
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City | DENTON
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State | TX
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Zip | 76210-0102
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Country | US
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Telephone | 463-814-4475
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Fax | 940-308-0055
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Provider Business Mailing Address
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Address Line | 6009 KENYON CT
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City | FLOWER MOUND
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State | TX
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Zip | 75028-2320
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Country | US
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Telephone | 940-600-2266
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Fax | 940-308-0055
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICKY LYNN HARRIS
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Credential | D.O.
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Telephone | 940-600-2266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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