Provider Demographics
NPI:1497793509
Name:WILFONG, LALAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:LALAN
Middle Name:SCOTT
Last Name:WILFONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:8220 WALNUT HILL LN
Practice Address - Street 2:SUITE 700, PROFESSIONAL BUILDING II
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4427
Practice Address - Country:US
Practice Address - Phone:214-739-4175
Practice Address - Fax:214-987-4161
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5744207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158076301Medicaid
TX158076304Medicaid
OK200235410AMedicaid
TX8R1590OtherBLUE CROSS OF TEXAS
TX158076302Medicaid
TX158076304Medicaid
TX158076301Medicaid
TXP00014423Medicare PIN
TX8R1590OtherBLUE CROSS OF TEXAS