Individual
RICHARD LAWRENCE WASSERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
7777 FOREST LN, SUITE B-332, DALLAS, TX 75230-2571
(972) 566-7788
(972) 566-8837
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
G4068
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346234614
—
TX
01
—
397487ZM3L
MEDICARE PTAN
TX
01
—
940841
MEDICARE PTAN
TX
Enumeration date
09/01/2005
Last updated
11/13/2023
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