Organization
LD WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOUIS DEGIRONEMO MD (PRINCIPAL)
(315) 796-1087
Entity
Organization
Contact information
Practice address
7331 GASTON AVE STE 219, DALLAS, TX 75214-4131
(315) 796-1087
Mailing address
1910 PACIFIC AVE STE 15700, DALLAS, TX 75201-4245
(214) 389-0855
(214) 389-0859
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
Q0036
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q0036
TMB
TX
Enumeration date
06/12/2018
Last updated
06/12/2018
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