Provider Demographics
NPI:1053324491
Name:LAKE ARLINGTON FAMILY MEDICINE, P.A.
Entity Type:Organization
Organization Name:LAKE ARLINGTON FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:POQUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-496-4957
Mailing Address - Street 1:3901 W GREEN OAKS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2795
Mailing Address - Country:US
Mailing Address - Phone:817-496-4957
Mailing Address - Fax:817-496-3783
Practice Address - Street 1:3901 W GREEN OAKS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2795
Practice Address - Country:US
Practice Address - Phone:817-496-4957
Practice Address - Fax:817-496-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty