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General NPI Number Information
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NPI Number | 1417220864
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Entity Type | Organization
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Legal Business Name | BOB LANIER MD PA
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 6407 SOUTHWEST BLVD
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City | BENBROOK
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State | TX
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Zip | 76132-2777
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Country | US
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Telephone | 817-731-9198
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Fax | 817-731-9199
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Provider Business Mailing Address
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Address Line | 6407 SOUTWEST BLVD.
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City | BENBROOK
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State | TX
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Zip | 76132-2777
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Country | US
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Telephone | 817-731-9198
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Fax | 817-731-9199
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Authorized Official
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Title or Position | OWNER
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Name | MR. BOB Q LANIER
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Credential | MD
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Telephone | 817-731-9198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | D7140
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License Number State | TX
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