MEDICARE: PLANO FAMILY CLINIC PLLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1346787603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANO FAMILY CLINIC PLLC

Provider Business Mailing Address
First Line	:	6100 K AVE
Second Line	:	SUITE 108
City	:	PLANO
State	:	TX
Zip	:	75074-2538
Country	:	US
Telephone Number	:	972-509-0752
Fax Number	:	972-509-4926

Provider Business Practice Location Address
First Line	:	6100 K AVE
Second Line	:	SUITE 108
City	:	PLANO
State	:	TX
Zip	:	75074-2538
Country	:	US
Telephone Number	:	972-509-0752
Fax Number	:	972-509-4926

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	ADRIANE ALEXANDER
Credential	:
Telephone Number	:	469-463-3353

Provider Enumeration Date	:	01/25/2017
Last Update Date	:	01/25/2017

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