| Gant | |
|
900 W Magnolia Ave Ste 100 Fort Worth TX 76104-8518 | |
| (817) 870-7300 | |
| (817) 332-8372 |
| Full Name | Gant |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 900 W Magnolia Ave Ste 100, Fort Worth, Texas |
| Authorized Official Name and Position | Kim Nelson Barham (OFFICE MANAGER) |
| Authorized Official Contact | 8178707300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gant 900 W Magnolia Ave Ste 100 Suite 100 Fort Worth TX 76104-8518 Ph: (817) 870-7300 | Gant 900 W Magnolia Ave Ste 100 Fort Worth TX 76104-8518 Ph: (817) 870-7300 |
| NPI Number | 1720005523 |
|---|---|
| Provider Enumeration Date | 07/16/2006 |
| Last Update Date | 09/22/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720005523 | NPI | - | NPPES |
| 085307902 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
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