Healthcare Provider Details

I. General information

NPI: 1689965345
Provider Name (Legal Business Name): ELLIOT RUTLEDGE ROW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 5TH AVE STE 300
FORT WORTH TX
76104-7303
US

IV. Provider business mailing address

3409 WORTH ST STE 300
DALLAS TX
75246-2039
US

V. Phone/Fax

Practice location:
  • Phone: 817-250-5690
  • Fax:
Mailing address:
  • Phone: 214-820-8350
  • Fax: 214-820-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR3200
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberR3200
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: