Provider Demographics
NPI:1407409436
Name:PARMER LANE MEDICAL OFFICE LLC
Entity Type:Organization
Organization Name:PARMER LANE MEDICAL OFFICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:EARTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-528-9498
Mailing Address - Street 1:11901 W PARMER LN STE 310
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7654
Mailing Address - Country:US
Mailing Address - Phone:512-528-9498
Mailing Address - Fax:512-843-7164
Practice Address - Street 1:11901 W PARMER LN STE 310
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7654
Practice Address - Country:US
Practice Address - Phone:512-528-9498
Practice Address - Fax:512-843-7164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIAN S. EARTHMAN MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health