Healthcare Provider Details

I. General information

NPI: 1932514817
Provider Name (Legal Business Name): ANAS HAMADEH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 9TH AVE STE 400
FORT WORTH TX
76104-3932
US

IV. Provider business mailing address

1000 W CANNON ST
FORT WORTH TX
76104-3029
US

V. Phone/Fax

Practice location:
  • Phone: 817-877-4105
  • Fax: 817-348-9797
Mailing address:
  • Phone: 817-725-7900
  • Fax: 682-207-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR2117
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number259914
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: