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General NPI Number Information
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NPI Number | 1093134512
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Entity Type | Organization
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Legal Business Name | SUPERIOR EVALUATION SERVICES
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Dates
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Enumeration Date | 04/11/2014
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Last Update Date | 04/11/2014
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Provider Practice Location Address
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Address Line | 420 THROCKMORTON SUITE 200
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City | FT. WORTH
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State | TX
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Zip | 76102
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Country | US
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Telephone | 817-863-4315
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Fax | 888-575-0212
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Provider Business Mailing Address
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Address Line | 4040 ALAVA DR
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City | FORT WORTH
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State | TX
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Zip | 76133-5555
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Country | US
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Telephone | 817-657-5199
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Fax | 888-575-0212
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Authorized Official
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Title or Position | OWNER
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Name | MR. JERRY REX BROOKS
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Credential |
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Telephone | 817-657-5199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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