Healthcare Provider Details

I. General information

NPI: 1316329170
Provider Name (Legal Business Name): SALLY KURZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SALLY DIERSCHKE M.D.

II. Dates (important events)

Enumeration Date: 06/28/2015
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 JOYCE DR STE 110E
FORT WORTH TX
76116-6419
US

IV. Provider business mailing address

107 LARSON LN STE 200
ALEDO TX
76008-4593
US

V. Phone/Fax

Practice location:
  • Phone: 817-841-9659
  • Fax:
Mailing address:
  • Phone: 817-841-9659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberR8929
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR8929
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: