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NPI Code Detail

MEDICARE: WADE AUMILLER PHD PA-C

MEDICARE: WADE AUMILLER PHD PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant
2363A00000XPhysician AssistantPA11132TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1363AS0400XOTHERTAXONOMY CODE

General Provider Information

NPI Number : 1194257139
Entity Type Code : Individual
Provider Name (Legal Business Name) : WADE AUMILLER PHD PA-C
Provider Business Mailing Address
First Line : 200 W MAGNOLIA AVE STE 201
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-7657
Country : US
Telephone Number : 817-702-2977
Fax Number : 817-702-2140
Provider Business Practice Location Address
First Line : 1500 S MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4917
Country : US
Telephone Number : 817-702-1100
Fax Number : 817-702-2140
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2017
Last Update Date : 03/05/2026

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Directions to “ WADE AUMILLER PHD PA-C” Practice Location

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