=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710477781
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONESTAR SPINAL ACCESS SURGEONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2018
-----------------------------------------------------
Last Update Date | 05/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17194 PRESTON RD STE 102-283
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75248-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-480-5845
-----------------------------------------------------
Fax | 972-248-6025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2600 ANDERS LN
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-5921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROBERT MARK HOYLE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 214-651-0772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------