Provider Demographics
NPI:1154322006
Name:MCNALLY, LAWRENCE B (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:B
Last Name:MCNALLY
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 1:6029 BELT LINE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-9109
Mailing Address - Country:US
Mailing Address - Phone:972-385-0000
Mailing Address - Fax:972-385-1231
Practice Address - Street 1:6029 BELT LINE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-9109
Practice Address - Country:US
Practice Address - Phone:972-385-0000
Practice Address - Fax:972-385-1231
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2013-01-23
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
TXG2780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00223RMedicare PIN
TXB24791Medicare UPIN