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Specialty details in registry · Fort Worth, TX

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At a glance

4300 Pecos St, Fort Worth, TX 76119-5162

NPPES record updated May 1, 2014. Public records can lag behind changes at a practice.

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Practice location

4300 Pecos St
Fort Worth, TX 76119-5162

Professional details: NPI, taxonomy & registry record

NPI1730599556

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 253Z00000X
Enumeration date: May 1, 2014
Record updated: May 1, 2014

More registry details

Provider type: Organization · Type 2
Other reported name: <UNAVAIL>

Reported taxonomies and licenses

Specialty details in registry

253Z00000X · Primary

License reported: 704199 TX

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

4300 Pecos St
Fort Worth, TX 76119-5162

Phone: (817) 706-8415

Mailing address

PO BOX 19096

FORT WORTH, TX 761191096

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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