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4504 Boat Club Rd Suite 800 Fort Worth TX 76135-7003 | |
| (817) 237-0515 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 4504 Boat Club Rd, Fort Worth, Texas |
| Authorized Official Name and Position | Bridgett Anderson (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 6822363622 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
251 Westpark Way Suite 200 Euless TX 76040-3742 Ph: (682) 236-3622 | 4504 Boat Club Rd Suite 800 Fort Worth TX 76135-7003 Ph: (817) 237-0515 |
| NPI Number | 1205806106 |
|---|---|
| Provider Enumeration Date | 01/24/2006 |
| Last Update Date | 03/09/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205806106 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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