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General NPI Number Information
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NPI Number | 1497038632
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Entity Type | Organization
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Legal Business Name | TARRANT GASTROENTEROLOGY ASSOCIATES PA
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 1111 5TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-4302
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Country | US
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Telephone | 817-877-0200
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Fax | 817-877-0203
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Provider Business Mailing Address
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Address Line | 3020 BELLAIRE RANCH DR APT 1517
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City | FORT WORTH
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State | TX
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Zip | 76109-1843
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Country | US
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Telephone | 817-877-0200
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Fax | 817-877-0203
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Authorized Official
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Title or Position | OWNER
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Name | PRIYA RANGASAMY
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Credential | MD
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Telephone | 817-877-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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