Provider Demographics
NPI:1053347534
Name:LACKAN, DARREN WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:DARREN
Middle Name:WAYNE
Last Name:LACKAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7801 OAKMONT BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4204
Mailing Address - Country:US
Mailing Address - Phone:817-263-0007
Mailing Address - Fax:817-263-1118
Practice Address - Street 1:7801 OAKMONT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4204
Practice Address - Country:US
Practice Address - Phone:817-263-0007
Practice Address - Fax:817-263-1118
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL6481207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163330703Medicaid
TX163330703Medicaid
TX8F5974Medicare PIN