Provider Demographics
NPI:1083920920
Name:FERTILITY SPECIALISTS OF TEXAS, PLLC
Entity Type:Organization
Organization Name:FERTILITY SPECIALISTS OF TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-618-2044
Mailing Address - Street 1:5757 WARREN PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4274
Mailing Address - Country:US
Mailing Address - Phone:214-618-2044
Mailing Address - Fax:214-618-2045
Practice Address - Street 1:5757 WARREN PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4274
Practice Address - Country:US
Practice Address - Phone:214-618-2044
Practice Address - Fax:214-618-2045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FERTILTIY SPECIALISTS OF DALLAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4157291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory