MEDICARE: DR. DAVIDA DENISE RIXTER M.D.

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
1	207L00000X	Anesthesiology Physician	125.050014	IL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	A119541	CA

General Provider Information

NPI Number	:	1215193990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVIDA DENISE RIXTER M.D.

Provider Business Mailing Address
First Line	:	5407 BASSWOOD BLVD STE 115
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4499
Country	:	US
Telephone Number	:	817-770-4471
Fax Number	:	817-770-4242

Provider Business Practice Location Address
First Line	:	5407 BASSWOOD BLVD STE 115
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4499
Country	:	US
Telephone Number	:	817-770-4471
Fax Number	:	817-770-4242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	02/22/2018

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