Provider Demographics
NPI:1114144763
Name:GONDOL, SARA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:GONDOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 LEGACY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6047
Mailing Address - Country:US
Mailing Address - Phone:214-494-4212
Mailing Address - Fax:214-494-4214
Practice Address - Street 1:1518 LEGACY DR STE 110
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6047
Practice Address - Country:US
Practice Address - Phone:214-494-4212
Practice Address - Fax:214-494-4214
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6149208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics