Organization
LAN LE, DO, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAN T LE D.O. (PRESIDENT)
(817) 336-7188
Entity
Organization
Contact information
Practice address
5632 EDWARDS RANCH RD STE 100, FORT WORTH, TX 76109-4149
(817) 336-7188
(844) 231-8865
Mailing address
P O BOX 678610, DALLAS, TX 75267-8610
(817) 336-7188
(817) 335-9039
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
N2163
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016SV
BCBS
TX
05
—
205978401
—
TX
Enumeration date
06/04/2009
Last updated
10/14/2021
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