Provider Demographics
NPI:1417220864
Name:BOB LANIER MD PA
Entity Type:Organization
Organization Name:BOB LANIER MD PA
Other - Org Name:LANIER ALLERGY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:Q
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-731-9198
Mailing Address - Street 1:6407 SOUTWEST BLVD.
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2777
Mailing Address - Country:US
Mailing Address - Phone:817-731-9198
Mailing Address - Fax:817-731-9199
Practice Address - Street 1:6407 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76132-2777
Practice Address - Country:US
Practice Address - Phone:817-731-9198
Practice Address - Fax:817-731-9199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOB LANIER MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7140207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty