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General NPI Number Information
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NPI Number | 1942500913
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Entity Type | Organization
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Legal Business Name | CAROLYN W. QUIST, DO, PA
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 03/25/2011
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Provider Practice Location Address
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Address Line | 1425 8TH AVENUE SUITE 101
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City | FORT WORTH
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State | TX
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Zip | 76104-4137
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Country | US
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Telephone | 817-926-1313
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Fax | 817-926-7434
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Provider Business Mailing Address
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Address Line | 1425 8TH AVENUE
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City | FORT WORTH
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State | TX
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Zip | 76104-4137
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Country | US
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Telephone | 817-926-1313
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Fax | 817-926-7434
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAROLYN W QUIST
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Credential | D.O.
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Telephone | 817-926-1313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | H2705
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License Number State | TX
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