MEDICARE: DR. THERESA D STRETCH 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	207R00000X	Internal Medicine Physician	BP20027635	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8CQ845	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1710218169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA D STRETCH M.D.

Provider Business Mailing Address
First Line	:	1806 W PLEASANT RIDGE RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-4530
Country	:	US
Telephone Number	:	817-635-6363
Fax Number	:	817-635-6362

Provider Business Practice Location Address
First Line	:	1806 W PLEASANT RIDGE RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-4530
Country	:	US
Telephone Number	:	817-635-6363
Fax Number	:	817-635-6362

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

Provider Enumeration Date	:	01/25/2010
Last Update Date	:	05/18/2012

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