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General NPI Number Information
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NPI Number | 1629650791
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Entity Type | Organization
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Legal Business Name | DOC D MEDICAL CONSULTING, PLLC
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 6913 CAMP BOWIE BLVD STE 107
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City | FORT WORTH
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State | TX
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Zip | 76116-7164
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Country | US
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Telephone | 817-367-9289
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Fax | 817-382-5217
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Provider Business Mailing Address
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Address Line | 6913 CAMP BOWIE BLVD STE 107
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City | FORT WORTH
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State | TX
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Zip | 76116-7164
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Country | US
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Telephone | 817-367-9289
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Fax | 817-382-5217
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | SHELLY SHEA
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Credential |
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Telephone | 817-484-6274
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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 |
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License Number State |
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