MEDICARE: MARTIN A. DERUSHA, JR., D.O,, P.A.

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	207Q00000X	Family Medicine Physician	K0454	TX

General Provider Information

NPI Number	:	1497801211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN A. DERUSHA, JR., D.O,, P.A.

Provider Business Mailing Address
First Line	:	1510 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2027
Country	:	US
Telephone Number	:	817-882-0984
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2027
Country	:	US
Telephone Number	:	817-882-0984
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARTIN ALLYN DERUSHA JR.
Credential	:	D.O.
Telephone Number	:	817-882-0984

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1922046507 — MARTIN A DERUSHA DO
Practice Location Address:

1506 PENNSYLVANIA AVE
FORT WORTH, TX
76104-2027

Practice Phone: 817-882-0984
Practice Fax: 817-882-9978

1619900933 — MR. MARVIN S. MATHEWS LMFT
Practice Location Address:

1506 PENNSYLVANIA AVE
FORT WORTH, TX
76104-2027

Practice Phone: 877-521-7927
Practice Fax: 817-719-0334

1235210717 — TEXAS D.M.E., INC.
Practice Location Address:

1516 PENNSYLVANIA AVE
FORT WORTH, TX
76104-2027

Practice Phone: 817-332-4235
Practice Fax:

1952458200 — DR. INSON STOLTZ DC
Practice Location Address:

1504 PENNSYLVANIA AVE
FT WORTH, TX
76104-2027

Practice Phone: 817-335-4878
Practice Fax: 817-335-4890

1457401135 — ACCIDENT & INJURY PAIN CENTERS, INC.
Practice Location Address:

1504 PENNSYLVANIA AVE
FT WORTH, TX
76104-2027

Practice Phone: 817-335-4878
Practice Fax: 817-335-4890

1700927761 — MS. SALLY ANN HARGER L.C.S.W.
Practice Location Address:

1506 PENNSYLVANIA AVE
FORT WORTH, TX
76104-2027

Practice Phone: 817-714-7023
Practice Fax:

Directions to “MARTIN A. DERUSHA, JR., D.O,, P.A. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.