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General NPI Number Information
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NPI Number | 1366937013
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Entity Type | Organization
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Legal Business Name | LD ANESTHESIA CONSULTANTS, PLLC
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | 5902 GOLIAD AVE
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City | DALLAS
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State | TX
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Zip | 75206-6820
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Country | US
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Telephone | 214-988-9188
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Fax |
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Provider Business Mailing Address
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Address Line | 5902 GOLIAD AVE
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City | DALLAS
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State | TX
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Zip | 75206-6820
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Country | US
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Telephone | 214-988-9188
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | LOUIS DEGIRONEMO
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Credential | MD
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Telephone | 214-988-9188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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