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General NPI Number Information
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NPI Number | 1851539209
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Entity Type | Organization
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Legal Business Name | FOREST LANE FAMILY MEDICINE, PA
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Dates
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Enumeration Date | 01/22/2009
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Last Update Date | 01/30/2015
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Provider Practice Location Address
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Address Line | 2601 FOREST LN
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City | GARLAND
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State | TX
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Zip | 75042-6508
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Country | US
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Telephone | 972-272-1632
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Fax | 972-272-5220
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Provider Business Mailing Address
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Address Line | 2601 FOREST LN
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City | GARLAND
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State | TX
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Zip | 75042-6508
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Country | US
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Telephone | 972-272-1632
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Fax | 972-272-5220
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Authorized Official
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Title or Position | MD
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Name | DR. WALTER RIOS
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Credential | MD
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Telephone | 972-272-1632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | L5110
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License Number State | TX
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