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General NPI Number Information
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NPI Number | 1255776605
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Entity Type | Individual
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Provider Name | GUADALUPE DE LA FUENTE JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 800 5TH AVE STE 300
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City | FORT WORTH
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State | TX
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Zip | 76104-7303
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Country | US
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Telephone | 817-878-5300
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Fax | 817-878-5321
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Provider Business Mailing Address
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Address Line | 800 5TH AVE STE 300
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City | FORT WORTH
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State | TX
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Zip | 76104-7303
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Country | US
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Telephone | 817-878-5300
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Fax | 817-878-5321
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 574739
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | S3150
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License Number State | TX
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