=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689789760
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GASTROENTEROLOGY AND ENDOSCOPY ASSOCIATES OF FORT WORTH, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 02/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6300 RIDGLEA PL STE 1103
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76116-5737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-926-9087
-----------------------------------------------------
Fax | 817-924-1268
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6300 RIDGLEA PL STE 1103
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76116-5737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-926-9087
-----------------------------------------------------
Fax | 817-924-1268
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NATARAJ G. KASAL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 817-926-9087
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | E5808
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------