Provider Demographics
NPI:1356681977
Name:LANKFORD, DERRICK D
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:D
Last Name:LANKFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7708 S LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-6404
Mailing Address - Country:US
Mailing Address - Phone:469-556-4664
Mailing Address - Fax:972-228-6693
Practice Address - Street 1:7708 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-6404
Practice Address - Country:US
Practice Address - Phone:469-556-4664
Practice Address - Fax:972-228-6693
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12915683171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications