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Organization
LIVE WELL MD PA
Active
Organization
LIVE WELL MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HENRY T HORRILLENO MD (OWNER)
(214) 388-4808
Entity
Organization
Contact information
Practice address
4808 S BUCKNER BLVD, DALLAS, TX 75227-2348
(214) 388-4808
Mailing address
4808 S BUCKNER BLVD, DALLAS, TX 75227-2348
(214) 388-4808
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
G1042
TX
Other
Enumeration date
07/07/2011
Last updated
07/07/2011
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