Organization
LIFEMD SOUTH CENTRAL PATIENT MEDICAL CARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC YECIES (CCO)
(800) 852-1575
Entity
Organization
Contact information
Practice address
325 N SAINT PAUL ST STE 3100, DALLAS, TX 75201-3923
(646) 263-3680
Mailing address
236 5TH AVE STE 400, NEW YORK, NY 10001-7606
(800) 852-1575
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
06/28/2023
Last updated
05/28/2024
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