Provider Demographics
NPI:1992022594
Name:PRIMO, LILY FATHY (MD)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:FATHY
Last Name:PRIMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:FATHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6900 SCENIC DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-2695
Mailing Address - Country:US
Mailing Address - Phone:972-475-7122
Mailing Address - Fax:972-412-0935
Practice Address - Street 1:6900 SCENIC DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-2695
Practice Address - Country:US
Practice Address - Phone:972-475-7122
Practice Address - Fax:972-412-0935
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9937207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX432550YMNYMedicare PIN