Provider Demographics
NPI:1124203229
Name:GLEN LAKES OB GYN PA
Entity Type:Organization
Organization Name:GLEN LAKES OB GYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DARROW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-692-8660
Mailing Address - Street 1:997 RAINTREE CIR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4949
Mailing Address - Country:US
Mailing Address - Phone:214-692-8660
Mailing Address - Fax:214-692-8096
Practice Address - Street 1:997 RAINTREE CIR
Practice Address - Street 2:SUITE 170
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4949
Practice Address - Country:US
Practice Address - Phone:214-692-8660
Practice Address - Fax:214-692-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00257WMedicare PIN