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General NPI Number Information
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NPI Number | 1689473068
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Entity Type | Organization
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Legal Business Name | LIFEGENIX MED PLLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 17230 DALLAS PKWY STE 110
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City | DALLAS
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State | TX
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Zip | 75248-1136
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Country | US
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Telephone | 972-236-3333
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Fax | 972-920-3754
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Provider Business Mailing Address
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Address Line | 17230 DALLAS PKWY STE 110
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City | DALLAS
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State | TX
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Zip | 75248-1136
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Country | US
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Telephone | 972-236-3333
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Fax | 972-920-3754
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | LAURIE CLEMONS
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Credential |
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Telephone | 972-236-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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