| NPI | 1871639757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN WAYNE LACKAN Owner 682-225-1157 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: TX L6481) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2025-09-23 |