Provider Demographics
NPI:1114984259
Name:LANIER, BOBBY QUENTIN (MD)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:QUENTIN
Last Name:LANIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:512-550-1800
Mailing Address - Fax:
Practice Address - Street 1:6310 SOUTHWEST BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3998
Practice Address - Country:US
Practice Address - Phone:817-731-9198
Practice Address - Fax:817-731-9199
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7140207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L511OtherBC/BS PROVIDER #
TX1058861004OtherCIGNA PROVIDER #
TX4341067OtherAETNA PROVIDER #
TXD66778Medicare UPIN