MEDICARE: PREMIER ALLERGIST OF FLORIDA LLC

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	207K00000X	Allergy & Immunology Physician

General Provider Information

NPI Number	:	1386596245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER ALLERGIST OF FLORIDA LLC

Provider Business Mailing Address
First Line	:	2500 LEGACY DR STE 100
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-5984
Country	:	US
Telephone Number	:	469-209-8355
Fax Number	:

Provider Business Practice Location Address
First Line	:	504 BROOKWOOD BLVD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6802
Country	:	US
Telephone Number	:	205-871-9661
Fax Number	:

Authorized Official
Title or Position	:	REVENUE INTEGRITY ADMINISTRATOR
Name	:	LILY FLYNN
Credential	:
Telephone Number	:	469-209-8355

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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