MEDICARE: RG MEDICAL

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	D6175	TX

General Provider Information

NPI Number	:	1962645754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RG MEDICAL

Provider Business Mailing Address
First Line	:	4716 E LANCASTER AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3836
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4716 E LANCASTER AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3836
Country	:	US
Telephone Number	:	817-413-8000
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SHIRLEY ODIWUOR
Credential	:
Telephone Number	:	817-413-8000

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	05/19/2009

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Directions to “RG MEDICAL ” Practice Location

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