MEDICARE: GLEN LAKES OB GYN PA

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1821348558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLEN LAKES OB GYN PA

Provider Business Mailing Address
First Line	:	8140 WALNUT HILL LANE
Second Line	:	SUITE 800
City	:	DALLAS
State	:	TX
Zip	:	75231-4396
Country	:	US
Telephone Number	:	214-692-8660
Fax Number	:	214-692-8096

Provider Business Practice Location Address
First Line	:	8140 WALNUT HILL LANE
Second Line	:	SUITE 800
City	:	DALLAS
State	:	TX
Zip	:	75231-4396
Country	:	US
Telephone Number	:	214-692-8660
Fax Number	:	214-692-8096

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT S DARROW
Credential	:	MD
Telephone Number	:	214-692-8660

Provider Enumeration Date	:	09/10/2012
Last Update Date	:	09/10/2012

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