Provider Demographics
NPI:1821553454
Name:LONESTAR WEIGHTLOSS
Entity Type:Organization
Organization Name:LONESTAR WEIGHTLOSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:469-463-0070
Mailing Address - Street 1:415 PENDALL DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5564
Mailing Address - Country:US
Mailing Address - Phone:469-463-0070
Mailing Address - Fax:
Practice Address - Street 1:5700 TENNYSON PKWY STE 350
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7249
Practice Address - Country:US
Practice Address - Phone:469-456-3303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty