# TROPHY CLUB FAMILY MEDICINE PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Trophy Club Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922093061
- **Authorized official:** LAINEY GEE (BUSINESS MANAGER)
- **Authorized official phone:** (817) 430-9111

## Contact information

- **Practice address:** 301 TROPHY LAKE DR, \#136, TROPHY CLUB, TX 76262-5238
- **Practice address phone:** (817) 430-9111
- **Practice address fax:** (817) 430-8911
- **Mailing address:** 301 TROPHY LAKE DR, \#136, TROPHY CLUB, TX 76262-5238
- **Mailing address phone:** (817) 430-9111
- **Mailing address fax:** (817) 430-8911

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/14/2005
- **Last updated:** 10/31/2007