=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437131901
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLINTON WARREN TWADDELL JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2005
-----------------------------------------------------
Last Update Date | 11/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5801 OAKBEND TRL STE 180
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76132-3915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-991-6117
-----------------------------------------------------
Fax | 888-812-8199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3820 NORTHDALE BLVD STE 201
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33624-1893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-991-6117
-----------------------------------------------------
Fax | 888-812-8191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | H6668
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------