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General NPI Number Information
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NPI Number | 1760422513
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Entity Type | Organization
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Legal Business Name | NORTH TEXAS RADIOLOGY PLLC
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 3712 W 7TH STREET SUITE A
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City | FORT WORTH
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State | TX
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Zip | 76107
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Country | US
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Telephone | 817-738-6571
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Fax | 817-738-6573
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Provider Business Mailing Address
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Address Line | PO BOX 1888
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City | GREENVILLE
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State | TX
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Zip | 75403
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Country | US
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Telephone | 800-945-2455
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Fax | 903-453-2541
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK A BAKER
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Credential | DO
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Telephone | 817-738-6571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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