Healthcare Provider Details

I. General information

NPI: 1043289937
Provider Name (Legal Business Name): KAUSAR JAVED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W TERRELL AVE FL 2
FORT WORTH TX
76104-2820
US

IV. Provider business mailing address

1300 W TERRELL AVE FL 2
FORT WORTH TX
76104-2820
US

V. Phone/Fax

Practice location:
  • Phone: 817-820-4906
  • Fax: 817-820-4815
Mailing address:
  • Phone: 817-820-4906
  • Fax: 817-820-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM1794
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: