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NPI Verification

National Provider Identifier: 1568116291

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Organization

Primary Specialty

Family Medicine

Code: 207Q00000X

All Specialties (7)

Specialist

Code: 174400000X

Family Medicine

Code: 207Q00000X

Primary

Internal Medicine

Code: 207R00000X

Clinic/Center, Multi-Specialty

Code: 261QM1300X

Physician Assistant

Code: 363A00000X

Physician Assistant, Medical

Code: 363AM0700X

Nurse Practitioner, Family

Code: 363LF0000X

Practice Address

2720 WESTERN CENTER BLVD STE 312

FORT WORTH, TX 761314302

Phone: 855-893-5637

NPI Enumeration Date

February 10, 2022

NPI Number

1568116291

Data sourced from the official CMS NPPES Registry. This information is provided by the Centers for Medicare & Medicaid Services and is updated regularly.

View on CMS NPPES Registry