MEDICARE: DW FIRST HEALTH

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1932886850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DW FIRST HEALTH

Provider Business Mailing Address
First Line	:	5350 LANSDOWNE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-1415
Country	:	US
Telephone Number	:	817-614-2364
Fax Number	:

Provider Business Practice Location Address
First Line	:	5350 LANSDOWNE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-1415
Country	:	US
Telephone Number	:	817-614-2364
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN ASSISTANT
Name	:	MR. DEREK WRZESINSKI
Credential	:	PA-C
Telephone Number	:	817-614-2364

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/03/2023

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Directions to “DW FIRST HEALTH ” Practice Location

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