=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487688594
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK A CONWAY DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 04/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7001 GRANBURY RD
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76133-5912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-346-1925
-----------------------------------------------------
Fax | 817-292-7237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7001 GRANBURY RD
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76133-5912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-346-1925
-----------------------------------------------------
Fax | 817-292-7237
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | L1008
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------