Provider Demographics
NPI:1215397294
Name:KFC MEDICAL PLLC
Entity Type:Organization
Organization Name:KFC MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-820-7246
Mailing Address - Street 1:PO BOX 650444
Mailing Address - Street 2:DEPT 121
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0444
Mailing Address - Country:US
Mailing Address - Phone:972-479-1115
Mailing Address - Fax:972-479-1118
Practice Address - Street 1:5045 LORIMAR DR
Practice Address - Street 2:SUITE 290
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5720
Practice Address - Country:US
Practice Address - Phone:972-403-1463
Practice Address - Fax:972-403-1465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8977103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty