National Provider Identifier Database

LIFE SPAN MEDICINE PA
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.


Contact Information

LIFE SPAN MEDICINE PA
2706 FAIRMONT STREET
DALLAS, TX75201
Phone: 214-303-1888
Fax: 214-303-1550
Website:
Specialty Taxonomy Code
* General Practice 208D00000X

* Indicates primary specialty

NPI Profile & details for LIFE SPAN MEDICINE PA

NPI Number 1679514632
Legal business name
LBN
LIFE SPAN MEDICINE PA
Authorized official GINA RENNA - (CEO)
Entity Organization
Organization subpart No
Enumeration date 06/09/2006
Last updated 04/07/2010 - About 16 years ago
Sole proprietor1 Not specified
Identifiers
  • Other: 0036HZ BLUE CROSS

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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