Healthcare Provider Details

I. General information

NPI: 1154785756
Provider Name (Legal Business Name): AMELIA EILEEN BUSH HOELSCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5751 EDWARDS RANCH RD STE 101
FORT WORTH TX
76109-4131
US

IV. Provider business mailing address

5751 EDWARDS RANCH RD STE 101
FORT WORTH TX
76109-4131
US

V. Phone/Fax

Practice location:
  • Phone: 817-923-9004
  • Fax: 817-923-9004
Mailing address:
  • Phone: 817-923-9004
  • Fax: 817-923-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberS3894
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: