Organization
LIFESTREAM HEALTH CENTER PA
Active
Parent organization
LIFESREAM HEALTH CENTER PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFESREAM HEALTH CENTER PA
Authorized official
DR. BRANDON C CHARLES M.D. (PRESIDENT)
(972) 304-6400
Entity
Organization
Contact information
Practice address
705 MAIN ST, COPPELL, TX 75019-4742
(972) 304-6400
(972) 304-6455
Mailing address
705 MAIN STREET, COPPELL, TX 75019
(972) 304-6400
(972) 304-6455
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
H6110
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H6110
TEXAS MEDICAL BOARD LICENSE
TX
Enumeration date
05/04/2009
Last updated
03/29/2016
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