Healthcare Provider Details

I. General information

NPI: 1578812905
Provider Name (Legal Business Name): HARRY PAPASOZOMENOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 PENNSYLVANIA AVE
FORT WORTH TX
76104-2224
US

IV. Provider business mailing address

816 W CANNON ST
FORT WORTH TX
76104-3146
US

V. Phone/Fax

Practice location:
  • Phone: 817-321-0300
  • Fax: 713-963-9051
Mailing address:
  • Phone: 817-321-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberP5701
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: