MEDICARE: WEST PLANO PHYSICIAN GROUP 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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician

General Provider Information

NPI Number	:	1518535830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST PLANO PHYSICIAN GROUP PLLC

Provider Business Mailing Address
First Line	:	6030 S RICE AVE STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-2944
Country	:	US
Telephone Number	:	713-660-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 DALLAS PKWY # 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4312
Country	:	US
Telephone Number	:	713-660-0555
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	TOM VO
Credential	:	MD
Telephone Number	:	713-660-0557

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	06/14/2021

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