MEDICARE: REPROMED FERTILITY CENTER 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	207VG0400X	Gynecology Physician	L5095	TX
2	207VE0102X	Reproductive Endocrinology Physician	L5095	TX

General Provider Information

NPI Number	:	1548547821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REPROMED FERTILITY CENTER PLLC

Provider Business Mailing Address
First Line	:	6411 ORCHID LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-4120
Country	:	US
Telephone Number	:	214-827-8777
Fax Number	:	214-827-8622

Provider Business Practice Location Address
First Line	:	3800 SAN JACINTO ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-5225
Country	:	US
Telephone Number	:	214-827-8777
Fax Number	:	214-827-8622

Authorized Official
Title or Position	:	OWNER
Name	:	ANIL PINTO
Credential	:	MD
Telephone Number	:	214-827-8777

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	11/14/2011

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Directions to “REPROMED FERTILITY CENTER PLLC ” Practice Location

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