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General NPI Number Information
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NPI Number | 1811067960
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Entity Type | Organization
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Legal Business Name | GWEN A. FIELDS, M.D., P.A.
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | 2931 RIDGE RD SUITE 115
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City | ROCKWALL
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State | TX
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Zip | 75032-6670
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Country | US
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Telephone | 972-772-5400
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Fax | 972-722-7303
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Provider Business Mailing Address
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Address Line | PO BOX 678413
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City | DALLAS
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State | TX
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Zip | 75267-8413
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Country | US
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Telephone | 972-772-5400
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Fax | 972-722-7303
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Authorized Official
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Title or Position | PRESIDENT
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Name | GWEN A. FIELDS
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Credential | M.D.
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Telephone | 972-772-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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