Provider Demographics
NPI:1730330754
Name:PACK, MARGARET W (PA-C)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:W
Last Name:PACK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 CLARA BARTON BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5738
Mailing Address - Country:US
Mailing Address - Phone:972-272-6561
Mailing Address - Fax:972-276-3067
Practice Address - Street 1:601 CLARA BARTON BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5738
Practice Address - Country:US
Practice Address - Phone:972-272-6561
Practice Address - Fax:972-276-3067
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05149363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00696073Medicare PIN
TX8L5827Medicare PIN