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General NPI Number Information
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NPI Number | 1225745854
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Entity Type | Organization
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Legal Business Name | MLD HEALTHCARE, LLC
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 6001 RICH ST
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City | FORT WORTH
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State | TX
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Zip | 76112-6500
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Country | US
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Telephone | 682-353-8171
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Fax | 682-353-8176
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Provider Business Mailing Address
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Address Line | 6001 RICH ST
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City | FORT WORTH
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State | TX
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Zip | 76112-6500
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Country | US
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Telephone | 682-353-8171
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Fax | 682-353-8176
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Authorized Official
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Title or Position | OWNER
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Name | MARVA DURGIN
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Credential | NP
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Telephone | 817-296-0782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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