MEDICARE: DRS MOBILE WOUND SPECIALISTS 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	208D00000X	General Practice Physician
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1417789272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS MOBILE WOUND SPECIALISTS PLLC

Provider Business Mailing Address
First Line	:	13509 LBJ FWY STE 200
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-4704
Country	:	US
Telephone Number	:	918-809-6133
Fax Number	:

Provider Business Practice Location Address
First Line	:	13509 LBJ FWY STE 200
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-4704
Country	:	US
Telephone Number	:	918-809-6133
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW ALLEN LAWRENCE
Credential	:	MD
Telephone Number	:	918-809-6133

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	10/11/2024

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