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General NPI Number Information
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NPI Number | 1447418041
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Entity Type | Individual
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Provider Name | WILLIAM T FOGARTY M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 15810 MIDWAY RD
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City | ADDISON
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State | TX
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Zip | 75001-4259
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Country | US
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Telephone | 972-458-8111
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Fax | 972-458-7776
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Provider Business Mailing Address
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Address Line | 5080 SPECTRUM DR
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City | ADDISON
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State | TX
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Zip | 75001-4648
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Country | US
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Telephone | 800-232-3550
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Fax |
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | F6629
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License Number State | TX
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