Healthcare Provider Details

I. General information

NPI: 1124087044
Provider Name (Legal Business Name): DONALD PATRICK FRUSHER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2327 N RIVERSIDE DR
FORT WORTH TX
76111-2904
US

IV. Provider business mailing address

2327 N RIVERSIDE DR
FORT WORTH TX
76111-2904
US

V. Phone/Fax

Practice location:
  • Phone: 817-834-1655
  • Fax: 817-834-1659
Mailing address:
  • Phone: 817-834-1655
  • Fax: 817-834-1659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK5531
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: