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General NPI Number Information
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NPI Number | 1265120240
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Entity Type | Organization
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Legal Business Name | DFW DIABETIC RELIEF LLC
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 208 N HIGHWAY 377
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City | ROANOKE
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State | TX
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Zip | 76262-6170
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Country | US
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Telephone | 214-929-7827
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Fax |
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Provider Business Mailing Address
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Address Line | 3575 LONE STAR CIR STE 424
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City | FORT WORTH
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State | TX
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Zip | 76177-8908
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Country | US
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Telephone | 214-929-7827
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIC WERNER
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Credential |
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Telephone | 214-929-7827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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