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General NPI Number Information
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NPI Number | 1265443030
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Entity Type | Organization
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Legal Business Name | WICHITA FALLS INFECTIOUS DISEASE ASSOC. P.A.
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 1601 BROOK AVE
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City | WICHITA FALLS
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State | TX
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Zip | 76301-5619
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Country | US
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Telephone | 940-723-9226
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Fax | 940-723-9217
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Provider Business Mailing Address
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Address Line | 1601 BROOK AVE
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City | WICHITA FALLS
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State | TX
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Zip | 76301-5619
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Country | US
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Telephone | 940-723-9226
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Fax | 940-723-9217
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARY M BROOKING
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Credential | CMOM, CMIS
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Telephone | 940-723-9226
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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 | F6922
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License Number State | TX
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