Provider Demographics
NPI:1245405273
Name:MALE FERTILITY SPECIALISTS, P.A.
Entity Type:Organization
Organization Name:MALE FERTILITY SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-612-7131
Mailing Address - Street 1:5616 WARREN PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4166
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5616 WARREN PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4166
Practice Address - Country:US
Practice Address - Phone:972-612-7131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9071174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD05177Medicare UPIN