Provider Demographics
NPI:1285028142
Name:TARPON PA
Entity Type:Organization
Organization Name:TARPON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERIWETHER
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:972-596-1059
Mailing Address - Street 1:5425 W SPRING CREEK PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4236
Mailing Address - Country:US
Mailing Address - Phone:972-596-1059
Mailing Address - Fax:972-612-5410
Practice Address - Street 1:17051 DALLAS PKWY
Practice Address - Street 2:SUITE 320
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7109
Practice Address - Country:US
Practice Address - Phone:972-596-1059
Practice Address - Fax:972-612-5410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9037207LP2900X, 207X00000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330923Medicare PIN