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General NPI Number Information
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NPI Number | 1649274135
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Entity Type | Individual
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Provider Name | CRAIG MAHLON WOMELDORPH DO
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 6317 HARRIS PKWY STE 300
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City | FORT WORTH
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State | TX
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Zip | 76132-4258
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Country | US
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Telephone | 817-361-6900
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Fax | 817-522-1968
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Provider Business Mailing Address
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Address Line | PO BOX 35629
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City | DALLAS
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State | TX
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Zip | 75235-0629
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Country | US
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Telephone | 214-424-2200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 156841
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101017580
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 5101017580
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License Number State | MI
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