| Lakeside Family Practice | |
|
6800 Heritage Pkwy Suite 102 Rockwall TX 75087-8746 | |
| (972) 463-2991 | |
| (942) 463-2997 |
| Full Name | Lakeside Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 6800 Heritage Pkwy, Rockwall, Texas |
| Authorized Official Name and Position | Robert Lawrence Magruder (OWNER) |
| Authorized Official Contact | 9724632991 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Family Practice 6800 Heritage Pkwy Suite 102 Rockwall TX 75087-8746 Ph: (972) 463-2991 | Lakeside Family Practice 6800 Heritage Pkwy Suite 102 Rockwall TX 75087-8746 Ph: (972) 463-2991 |
| NPI Number | 1245400779 |
|---|---|
| Provider Enumeration Date | 03/12/2008 |
| Last Update Date | 03/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245400779 | NPI | - | NPPES |
| 00980W | Other | TX | PTAM |
| 100200 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G5325 (Texas) | Primary |
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