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Organization
SOUTHLAKE PREMIER ANESTHESIA, PLLC
Active
Organization
SOUTHLAKE PREMIER ANESTHESIA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVERLY MILLER (CREDENTIALING SPECIALIST)
(210) 996-6363
Entity
Organization
Contact information
Practice address
3200 N TARRANT PKWY, FORT WORTH, TX 76177-8611
(210) 996-6363
Mailing address
2600 E SOUTHLAKE BLVD STE 120, SOUTHLAKE, TX 76092-8045
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
Other
Enumeration date
12/05/2019
Last updated
12/05/2019
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