Healthcare Provider Details

I. General information

NPI: 1023052909
Provider Name (Legal Business Name): CHARLES E ANDREWS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W MAGNOLIA AVE
FORT WORTH TX
76104
US

IV. Provider business mailing address

950 W MAGNOLIA AVE
FORT WORTH TX
76104
US

V. Phone/Fax

Practice location:
  • Phone: 817-336-5060
  • Fax: 817-336-1744
Mailing address:
  • Phone: 817-336-5060
  • Fax: 817-336-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberF8393
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: