| Executive Medicine Of Texas | |
|
2106 E State Highway 114 Ste 300 Southlake TX 76092 | |
| (817) 552-4300 | |
| Not Available |
| Full Name | Executive Medicine Of Texas |
|---|---|
| Speciality | Family Medicine |
| Location | 2106 E State Highway 114, Southlake, Texas |
| Authorized Official Name and Position | Walter Gaman (PHYSICIAN/PARTNER) |
| Authorized Official Contact | 8173079312 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Executive Medicine Of Texas 2106 E State Highway 114 Ste 300 Southlake TX 76092 Ph: (817) 552-4300 | Executive Medicine Of Texas 2106 E State Highway 114 Ste 300 Southlake TX 76092 Ph: (817) 552-4300 |
| NPI Number | 1043720154 |
|---|---|
| Provider Enumeration Date | 10/03/2017 |
| Last Update Date | 10/03/2017 |
| Medicare PECOS PAC ID | 5395150940 |
|---|---|
| Medicare Enrollment ID | O20210212001880 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043720154 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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