MEDICARE: BOB LEE PANSICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G4042	TX

General Provider Information

NPI Number	:	1326102138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOB LEE PANSICK MD

Provider Business Mailing Address
First Line	:	12200 PARK CENTRAL DR STE 180
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-2123
Country	:	US
Telephone Number	:	214-320-8785
Fax Number	:	214-320-8983

Provider Business Practice Location Address
First Line	:	12200 PARK CENTRAL DR STE 180
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-2123
Country	:	US
Telephone Number	:	214-320-8785
Fax Number	:	214-320-8983

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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