Provider Demographics
NPI:1326373143
Name:DIABETES AND THYROID CENTER OF FORT WORTH, PLLC
Entity type:Organization
Organization Name:DIABETES AND THYROID CENTER OF FORT WORTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LACKAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:682-225-1157
Mailing Address - Street 1:6844 HARRIS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4281
Mailing Address - Country:US
Mailing Address - Phone:817-263-0007
Mailing Address - Fax:817-263-1118
Practice Address - Street 1:6844 HARRIS PARKWAY
Practice Address - Street 2:
Practice Address - City:FT. WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-263-0007
Practice Address - Fax:817-263-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209175301Medicaid
TX0A5698Medicare PIN