Organization
SOUTHLAKE NEUROLOGY AND
Active
Organization
SOUTHLAKE NEUROLOGY AND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ASHER S. IMAM D.O. (PRESIDENT)
(817) 421-2905
Entity
Organization
Contact information
Practice address
175 STONEBRIDGE LN STE 100, SOUTHLAKE, TX 76092-0307
(817) 421-2905
(817) 431-6459
Mailing address
175 STONEBRIDGE LN STE 100, SOUTHLAKE, TX 76092-0307
(817) 421-2905
(817) 431-6459
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10582985
CAQH ID
—
01
—
K9573
TEXAS LICENSE
TX
Enumeration date
05/07/2007
Last updated
09/28/2020
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