Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | L6481 | TX |
N | 111NI0900X | Internist | L6481 | TX |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | L6481 | TX |
NPI | 1053347534 |
---|---|
Provider Name | Dr. Darren Wayne Lackan |
First Address | Fort Worth, TX 76132-4204 |
Second Address | Fort Worth, TX 76132-4204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 28/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
163330703 | (05) | TX |
I00954 | (02) |