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General NPI Number Information
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NPI Number | 1073773867
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Entity Type | Individual
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Provider Name | MOLLY MAE WARTHAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2008
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 5751 EDWARDS RANCH RD STE 101
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City | FORT WORTH
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State | TX
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Zip | 76109-4131
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Country | US
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Telephone | 817-923-8220
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Fax | 817-923-9004
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Provider Business Mailing Address
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Address Line | 5751 EDWARDS RANCH RD STE 101
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City | FORT WORTH
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State | TX
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Zip | 76109-4131
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Country | US
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Telephone | 817-923-8220
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Fax | 817-923-9004
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME106298
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD038210
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | N2335
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | N2335
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License Number State | TX
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