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General NPI Number Information
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NPI Number | 1871093195
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Entity Type | Organization
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Legal Business Name | LONE STAR MED PC
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Dates
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Enumeration Date | 02/13/2018
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Last Update Date | 02/15/2018
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Provider Practice Location Address
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Address Line | 7400 E OSBORN RD
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6432
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Country | US
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Telephone | 480-882-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 5110 N 44TH ST STE L200
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City | PHOENIX
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State | AZ
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Zip | 85018-1675
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Country | US
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Telephone | 602-343-2900
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Fax | 602-532-7753
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | VIKRAM DEKA
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Credential | MD
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Telephone | 480-221-1162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number |
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License Number State |
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