Organization
LAKESHORE ANESTHESIA GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD B. MILLSON CRNA (PRESIDENT)
(214) 236-5643
Entity
Organization
Contact information
Practice address
9440 POPPY DR, DALLAS, TX 75218-3652
(214) 324-6100
(214) 324-6141
Mailing address
PO BOX 181780, DALLAS, TX 75218-8780
(214) 236-5643
(214) 321-9160
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C09V
BCBS
TX
05
—
185036401
—
TX
Enumeration date
06/01/2006
Last updated
06/25/2008
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