Provider Demographics
NPI:1689896045
Name:LAWRENCE B MCNALLY INC
Entity Type:Organization
Organization Name:LAWRENCE B MCNALLY INC
Other - Org Name:LAWRENCE B MCNALLY, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-385-0000
Mailing Address - Street 1:6029 BELT LINE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7873
Mailing Address - Country:US
Mailing Address - Phone:972-385-0000
Mailing Address - Fax:972-385-1231
Practice Address - Street 1:6029 BELT LINE RD SUITE 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7873
Practice Address - Country:US
Practice Address - Phone:972-385-0000
Practice Address - Fax:972-385-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00223ROtherTPAN
TX8A1741OtherBCBS #
TX611291OtherAETNA ID#
TXY22583Medicare UPIN