Provider Demographics
NPI:1841454253
Name:LWM MEDICAL PRACTICE, PLLC
Entity type:Organization
Organization Name:LWM MEDICAL PRACTICE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LADELLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-684-3695
Mailing Address - Street 1:4447 N CENTRAL EXPY
Mailing Address - Street 2:STE. 110, PMB 277
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4245
Mailing Address - Country:US
Mailing Address - Phone:214-684-3695
Mailing Address - Fax:
Practice Address - Street 1:4447 N CENTRAL EXPY
Practice Address - Street 2:STE. 110, PMB 277
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-4245
Practice Address - Country:US
Practice Address - Phone:214-684-3695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0294208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty