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General NPI Number Information
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NPI Number | 1215013511
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Entity Type | Organization
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Legal Business Name | WEST TEXAS INTERNAL MEDICINE CLINIC
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Dates
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Enumeration Date | 10/29/2006
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Last Update Date | 04/03/2008
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Provider Practice Location Address
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Address Line | 7100 OAKMONT BLVD SUITE 105
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City | FORT WORTH
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State | TX
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Zip | 76132-3900
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Country | US
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Telephone | 817-292-2700
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Fax | 817-292-9806
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Provider Business Mailing Address
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Address Line | 7100 OAKMONT BLVD SUITE 105
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City | FORT WORTH
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State | TX
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Zip | 76132-3900
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Country | US
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Telephone | 817-292-2700
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Fax | 817-292-9806
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Authorized Official
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Title or Position | OWNER
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Name | JIM J GUERRA
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Credential | MD
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Telephone | 817-292-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | J2590
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License Number State | TX
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