Healthcare Provider Details

I. General information

NPI: 1659569556
Provider Name (Legal Business Name): FORT WORTH FERTILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MISTLETOE BLVD
FORT WORTH TX
76104-4062
US

IV. Provider business mailing address

1800 MISTLETOE BLVD
FORT WORTH TX
76104-4062
US

V. Phone/Fax

Practice location:
  • Phone: 817-348-8145
  • Fax: 817-348-8264
Mailing address:
  • Phone: 817-348-8145
  • Fax: 817-348-8264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberM0125
License Number StateTX

VIII. Authorized Official

Name: DR. ROBERT ALAN KAUFMANN
Title or Position: OWNER
Credential: M.D.
Phone: 817-348-8145