Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Southlake Physical Medicine PLLC

Organization Internal Medicine Physician · NPI 1083088900

Southlake Physical Medicine PLLC is an Internal Medicine Physician in Southlake, Texas. Registered with an NPI since 2015.

In the registry since
2015
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1500 W Southlake Blvd Ste 120
Southlake, TX 76092-5950
Phone: (817) 416-6116
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X

Record details

NPI number1083088900
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Gary Tigges — Medical Director · (972) 981-8345
NPI enumeratedNovember 16, 2015
Last updated in NPPESApril 29, 2016
Mailing address1500 W Southlake Blvd, Suite 120, Southlake, TX 76092-5950

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