Provider Demographics
NPI:1679883755
Name:TEXOMA ALLERGY GROUP, PLLC
Entity type:Organization
Organization Name:TEXOMA ALLERGY GROUP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A,
Authorized Official - Last Name:VAN WAGONER
Authorized Official - Suffix:
Authorized Official - Credentials:PA MD
Authorized Official - Phone:972-398-3500
Mailing Address - Street 1:6101 WINDCOM COURT
Mailing Address - Street 2:STE 400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7817
Mailing Address - Country:US
Mailing Address - Phone:972-398-3500
Mailing Address - Fax:972-398-3512
Practice Address - Street 1:5012 SOUTH US HIGHWAY 75
Practice Address - Street 2:SUITE 150
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020
Practice Address - Country:US
Practice Address - Phone:972-398-3500
Practice Address - Fax:972-398-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty