Healthcare Provider Details

I. General information

NPI: 1063852846
Provider Name (Legal Business Name): POONAM PURI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 8TH AVE
FT WORTH TX
76104-3902
US

IV. Provider business mailing address

900 8TH AVE
FT WORTH TX
76104-3902
US

V. Phone/Fax

Practice location:
  • Phone: 817-877-5292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberBP10045576
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: