Healthcare Provider Details

I. General information

NPI: 1679532840
Provider Name (Legal Business Name): TED E. FOGWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8160 WALNUT HILL LN SUITE 220
DALLAS TX
75231-4339
US

IV. Provider business mailing address

8160 WALNUT HILL LN SUITE 220
DALLAS TX
75231-4339
US

V. Phone/Fax

Practice location:
  • Phone: 214-750-0980
  • Fax:
Mailing address:
  • Phone: 214-750-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE0917
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: