| Doctor Mom Pllc | |
|
1333 W Mcdermott Dr Ste 150 Allen TX 75013-3088 | |
| (972) 478-0696 | |
| (844) 296-5471 |
| Full Name | Doctor Mom Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1333 W Mcdermott Dr Ste 150, Allen, Texas |
| Authorized Official Name and Position | Shauntelle Dene Bonman (PHYSICIAN) |
| Authorized Official Contact | 9722849498 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Doctor Mom Pllc 1120 Shadetree Ln Allen TX 75013-5415 Ph: () - | Doctor Mom Pllc 1333 W Mcdermott Dr Ste 150 Allen TX 75013-3088 Ph: (972) 478-0696 |
| NPI Number | 1750941118 |
|---|---|
| Provider Enumeration Date | 06/18/2019 |
| Last Update Date | 10/25/2019 |
| Medicare PECOS PAC ID | 7416284195 |
|---|---|
| Medicare Enrollment ID | O20190805001375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750941118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Shauntelle Dene Bonman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811272719 PECOS PAC ID: 3476799578 Enrollment ID: I20180206001159 |
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