Provider Demographics
NPI:1760523799
Name:PLANO FAMILY PRACTICE AND SPORTS MEDICINE, P.A.
Entity Type:Organization
Organization Name:PLANO FAMILY PRACTICE AND SPORTS MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-378-5250
Mailing Address - Street 1:6124 W PARKER RD STE 436
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8125
Mailing Address - Country:US
Mailing Address - Phone:972-378-5250
Mailing Address - Fax:972-378-6919
Practice Address - Street 1:6124 W PARKER RD STE 436
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8125
Practice Address - Country:US
Practice Address - Phone:972-378-5250
Practice Address - Fax:972-378-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00894NMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER