Healthcare Provider Details

I. General information

NPI: 1619481637
Provider Name (Legal Business Name): JONATHAN C. SNEAD, MD, PA DBA: ALLIANCE WOMEN'S HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10932 N RIVERSIDE DR STE 100
FORT WORTH TX
76244-7137
US

IV. Provider business mailing address

10932 N RIVERSIDE DR STE 100
FORT WORTH TX
76244-7137
US

V. Phone/Fax

Practice location:
  • Phone: 817-741-9663
  • Fax: 817-741-3691
Mailing address:
  • Phone: 817-741-9663
  • Fax: 817-741-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberL6186
License Number StateTX

VIII. Authorized Official

Name: DR. JONATHAN CASTLE SNEAD II
Title or Position: CEO/PHYSICIAN
Credential: MD
Phone: 817-741-9663