Healthcare Provider Details

I. General information

NPI: 1871553081
Provider Name (Legal Business Name): SANDRA K. IMES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7232 NORTH FREEWAY
FORT WORTH TX
76137
US

IV. Provider business mailing address

7232 NORTH FREEWAY
FORT WORTH TX
76137
US

V. Phone/Fax

Practice location:
  • Phone: 817-439-8100
  • Fax: 817-439-8103
Mailing address:
  • Phone: 817-439-8100
  • Fax: 817-439-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK0071
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: