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General NPI Number Information
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NPI Number | 1184328403
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Entity Type | Individual
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Provider Name | JOSEPH NATHAN LIDDLE MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 04/19/2025
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Provider Practice Location Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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Country | US
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Telephone | 817-702-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 520 SAMUELS AVE APT 9204
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City | FORT WORTH
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State | TX
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Zip | 76102-8635
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Country | US
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Telephone | 801-691-6437
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | V3367
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License Number State | TX
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