Healthcare Provider Details

I. General information

NPI: 1427127968
Provider Name (Legal Business Name): TEXAS PULMONARY & CRITICAL CARE CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 FAIRMOUNT AVE
FORT WORTH TX
76104-4215
US

IV. Provider business mailing address

1201 FAIRMOUNT AVE
FORT WORTH TX
76104-4215
US

V. Phone/Fax

Practice location:
  • Phone: 817-335-5288
  • Fax: 817-338-0927
Mailing address:
  • Phone: 817-335-5288
  • Fax: 817-338-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: KERIM F RAZACK
Title or Position: PHYSICIAN SHAREHOLDER
Credential: MD
Phone: 817-335-5288