MEDICARE: GIDEON OFISI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP132772	TX

General Provider Information

NPI Number	:	1033655915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIDEON OFISI

Provider Business Mailing Address
First Line	:	5200 BLUE QUARTZ RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-7326
Country	:	US
Telephone Number	:	316-807-1281
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 BLUE QUARTZ RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-7326
Country	:	US
Telephone Number	:	316-807-1281
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MR. GIDEON W OFISI
Credential	:	ARNP
Telephone Number	:	316-807-1281

Provider Enumeration Date	:	01/16/2017
Last Update Date	:	01/16/2017

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