Healthcare Provider Details

I. General information

NPI: 1437118775
Provider Name (Legal Business Name): WEATHERFORD ANESTHESIA ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 EUREKA ST STE B
WEATHERFORD TX
76086-5880
US

IV. Provider business mailing address

PO BOX 163694
FORT WORTH TX
76161-3694
US

V. Phone/Fax

Practice location:
  • Phone: 817-598-8150
  • Fax: 817-599-4902
Mailing address:
  • Phone: 888-991-1101
  • Fax: 903-787-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. JON-PAUL HARMER
Title or Position: OWNER
Credential: M.D.
Phone: 817-599-4901