Provider Demographics
NPI:1083332480
Name:B L WASSON DO PA INTERNAL MEDICINE
Entity Type:Organization
Organization Name:B L WASSON DO PA INTERNAL MEDICINE
Other - Org Name:I MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-410-3803
Mailing Address - Street 1:2560 CENTRAL PARK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1566
Mailing Address - Country:US
Mailing Address - Phone:972-410-3803
Mailing Address - Fax:
Practice Address - Street 1:2560 CENTRAL PARK AVE STE 140
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1566
Practice Address - Country:US
Practice Address - Phone:972-410-3803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty