Healthcare Provider Details

I. General information

NPI: 1285884809
Provider Name (Legal Business Name): GORDON G. MCWATT, D.O., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 BRIDGE ST SUITE 500
FORT WORTH TX
76112-2384
US

IV. Provider business mailing address

5601 BRIDGE ST SUITE 500
FORT WORTH TX
76112-2384
US

V. Phone/Fax

Practice location:
  • Phone: 817-457-9850
  • Fax: 817-287-0001
Mailing address:
  • Phone: 817-457-9850
  • Fax: 817-287-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberJ6589
License Number StateTX

VIII. Authorized Official

Name: DR. GORDON G. MCWATT
Title or Position: PRESIDENT
Credential: D.O.
Phone: 817-457-9850