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General NPI Number Information
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NPI Number | 1871760421
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Entity Type | Organization
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Legal Business Name | R G MEDICAL PLLC
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 5001 BRENTWOOD STAIR RD SUITE 107
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City | FORT WORTH
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State | TX
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Zip | 76112-2801
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Country | US
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Telephone | 817-687-1501
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Fax | 817-687-1500
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Provider Business Mailing Address
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Address Line | 5001 BRENTWOOD STAIR RD SUITE 107
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City | FORT WORTH
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State | TX
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Zip | 76112-2801
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Country | US
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Telephone | 817-687-1501
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Fax | 817-687-1500
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | BYRON GRIFFITH
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Credential |
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Telephone | 817-687-1501
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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 | D7045
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License Number State | TX
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