Healthcare Provider Details

I. General information

NPI: 1144800368
Provider Name (Legal Business Name): KAREN M VAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 N RIVERSIDE DR
FORT WORTH TX
76244-2118
US

IV. Provider business mailing address

PO BOX 99213
FORT WORTH TX
76199-0213
US

V. Phone/Fax

Practice location:
  • Phone: 817-347-2600
  • Fax: 817-347-2670
Mailing address:
  • Phone: 682-885-1860
  • Fax: 682-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW8458
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: