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100 W Southlake Blvd Ste 410 Southlake TX 76092-6166 | |
| (817) 310-6604 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 100 W Southlake Blvd Ste 410, Southlake, Texas |
| Authorized Official Name and Position | Robert Meyer (OWNER) |
| Authorized Official Contact | 8173106604 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
100 W Southlake Blvd Ste 410 Southlake TX 76092-6166 Ph: (817) 310-6604 | 100 W Southlake Blvd Ste 410 Southlake TX 76092-6166 Ph: (817) 310-6604 |
| NPI Number | 1730664657 |
|---|---|
| Provider Enumeration Date | 09/26/2018 |
| Last Update Date | 01/14/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730664657 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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