Organization
LUCKY STAR EMERGENCY PHYSICIANS, PPLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM C. JERNBERG M.D. (OFFICER)
(469) 401-2386
Entity
Organization
Contact information
Practice address
3500 GASTON AVE, DALLAS, TX 75246-2017
(469) 401-2386
Mailing address
P.O. BOX 98941, LAS VEGAS, NV 89193-8941
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/15/2015
Last updated
10/27/2015
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