Provider Demographics
NPI:1679200885
Name:SUMMIT BARIATRIC AND ROBOTIC SURGICAL SPECIALISTS PLLC
Entity Type:Organization
Organization Name:SUMMIT BARIATRIC AND ROBOTIC SURGICAL SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-755-6559
Mailing Address - Street 1:9330 LBJ FWY STE 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4310
Mailing Address - Country:US
Mailing Address - Phone:972-792-5700
Mailing Address - Fax:
Practice Address - Street 1:1201 S MAIN ST STE 111
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2838
Practice Address - Country:US
Practice Address - Phone:830-223-8150
Practice Address - Fax:830-223-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-07
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty