Provider Demographics
NPI:1639336787
Name:MAGNOLIA OBSTETRICS & GYNECOLOGY PLLC
Entity Type:Organization
Organization Name:MAGNOLIA OBSTETRICS & GYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-377-1699
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:601
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-377-1699
Mailing Address - Fax:214-824-8365
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:601
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-377-1699
Practice Address - Fax:214-824-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty