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General NPI Number Information
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NPI Number | 1437426723
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Entity Type | Organization
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Legal Business Name | NORTH CENTRAL TEXAS INFECTIOUS DISEASE GROUP PA
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 650 SAINT LOUIS AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-3346
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Country | US
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Telephone | 817-921-1886
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Fax |
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Provider Business Mailing Address
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Address Line | 1169 N BURLESON BLVD SUITE 107-235
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City | BURLESON
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State | TX
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Zip | 76028-7011
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Country | US
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Telephone | 817-921-1886
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Fax |
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Authorized Official
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Title or Position | D.O./PRESIDENT
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Name | EDWARD TOMOYE
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Credential | DO
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Telephone | 817-921-1886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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