Organization
FOREST LANE PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY GROSVENOR (MANAGER)
(972) 284-7776
Entity
Organization
Contact information
Practice address
7777 FOREST LN STE B300, DALLAS, TX 75230-2510
(972) 284-7770
(972) 284-7780
Mailing address
7777 FOREST LN STE B300, DALLAS, TX 75230-2510
(972) 284-7770
(972) 284-7780
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0070LM
BCBS
TX
Enumeration date
02/20/2007
Last updated
03/29/2017
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