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General NPI Number Information
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NPI Number | 1568785186
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Entity Type | Organization
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Legal Business Name | M. EBADAT ALI, MD, PA
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 1650 W ROSEDALE ST SUITE 203
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City | FORT WORTH
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State | TX
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Zip | 76104-7400
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Country | US
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Telephone | 817-336-8773
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 W ROSEDALE ST SUITE 203
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City | FORT WORTH
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State | TX
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Zip | 76104-7400
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Country | US
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Telephone | 817-336-8773
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHAMED EBADAT ALI
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Credential | MD
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Telephone | 817-336-8773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | E2970
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License Number State | TX
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