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General NPI Number Information
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NPI Number | 1578514535
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Entity Type | Organization
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Legal Business Name | T & R CLINIC A PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 2919 MARKUM DRIVE
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City | FORT WORTH
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State | TX
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Zip | 76117-4004
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Country | US
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Telephone | 817-831-0321
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Fax | 817-831-3211
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Provider Business Mailing Address
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Address Line | 2919 MARKUM DRIVE
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City | FORT WORTH
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State | TX
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Zip | 76117-4004
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Country | US
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Telephone | 817-831-0321
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Fax | 817-831-3211
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Authorized Official
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Title or Position | PRESIDENT/MEDICAL DOCTOR
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Name | SUCHITA D. REDDY
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Credential | M.D.
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Telephone | 817-831-0321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M1311
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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