Provider Demographics
NPI:1821348558
Name:GLEN LAKES OB GYN PA
Entity Type:Organization
Organization Name:GLEN LAKES OB GYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:DARROW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-692-8660
Mailing Address - Street 1:8140 WALNUT HILL LANE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4396
Mailing Address - Country:US
Mailing Address - Phone:214-692-8660
Mailing Address - Fax:214-692-8096
Practice Address - Street 1:8140 WALNUT HILL LANE
Practice Address - Street 2:SUITE 800
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4396
Practice Address - Country:US
Practice Address - Phone:214-692-8660
Practice Address - Fax:214-692-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty