Healthcare Provider Details

I. General information

NPI: 1134134406
Provider Name (Legal Business Name): EMILY B MCLAUGHLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W. MAGNOLIA AVE SUITE 110
FORT WORTH TX
76104-4833
US

IV. Provider business mailing address

PO BOX 961205
FORT WORTH TX
76161-1205
US

V. Phone/Fax

Practice location:
  • Phone: 817-870-4833
  • Fax: 817-870-4893
Mailing address:
  • Phone: 817-740-8400
  • Fax: 817-870-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberL7481
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: