45D2071972 CLIA NUMBER - MODERN MALE T CLINIC

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Laboratory Demographics

CLIA Number: 45D2071972

Facility Name: MODERN MALE T CLINIC

Facility Address:
15340 NORTH DALLAS PKWY STE 2400
DALLAS, TX
ZIP 75248
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Facility Phone Number: 972 865-6506

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1518389022

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	45D2071972
LAB Type	Physician Office
Facility Name	MODERN MALE T CLINIC
Street	15340 NORTH DALLAS PKWY STE 2400
City	DALLAS
State	TX
ZIP	75248
Phone	972 865-6506
CertificateType	2
CertificateEffectiveDate	1/22/2024
CertificateExpirationDate	1/21/2026
FacilityType	Compliance

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This page was last updated on: 4/23/2024