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General NPI Number Information
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NPI Number | 1770944076
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Entity Type | Organization
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Legal Business Name | CTPC FORT WORTH, PLLC
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Dates
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Enumeration Date | 03/14/2016
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 72356 BOAT CLUB ROAD
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City | FORT WORTH
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State | TX
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Zip | 76179-4555
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Country | US
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Telephone | 817-667-9535
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Fax | 817-667-9536
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Provider Business Mailing Address
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Address Line | 7235 BOAT CLUB RD
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City | FORT WORTH
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State | TX
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Zip | 76179-4555
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Country | US
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Telephone | 817-667-9535
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Fax | 817-667-9536
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Authorized Official
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Title or Position | OWNER
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Name | ERIC JAMES MILLER
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Credential | MD
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Telephone | 817-667-9535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | Q6623
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | Q6623
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License Number State | TX
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