Southlake Weight Loss, LLC

NPI #1710342241 in Southlake, Texas

Provider Information

NPI Number: 1710342241
Entity Type: Organization
Organization Name: Southlake Weight Loss, LLC
Primary Specialty: Family Medicine
Enumeration Date: Dec 29, 2015
Last Updated: Dec 29, 2015

Practice Location

Address: 601 E SOUTHLAKE BLVD
Address 2: SUITE 200
City: Southlake
State: Texas
ZIP Code: 76092-6251
Phone: (817) 488-1956

Authorized Official

Name: MR. STEPHEN JOEL OREN
Title: MANAGING MEMBER
Phone: (817) 271-4154

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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