Basic Information
| Provider Information | |||||||||
| NPI: | 1538703525 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLANO PROFESSIONAL ASSOCIATES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5960 W PARKER ROAD STE 278 - 415 | ||||||||
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| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143907697 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Practice Location | |||||||||
| Address1: | 5316 W PLANO PKWY | ||||||||
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| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750934821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143907697 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2019 | ||||||||
| LastUpdateDate: | 11/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | WILCOX | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 2143907697 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.