MEDICARE: LOW T MENS CLINIC LP

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	363LF0000X	Family Nurse Practitioner
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1053670257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOW T MENS CLINIC LP

Provider Business Mailing Address
First Line	:	5604 COLLEYVILLE BLVD STE H
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-6036
Country	:	US
Telephone Number	:	817-416-5698
Fax Number	:	817-416-5699

Provider Business Practice Location Address
First Line	:	5604 COLLEYVILLE BLVD STE H
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-6036
Country	:	US
Telephone Number	:	817-416-5698
Fax Number	:	817-416-5699

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IVONNE BRAXTON
Credential	:	FNP-BC
Telephone Number	:	956-650-0186

Provider Enumeration Date	:	05/08/2012
Last Update Date	:	02/03/2025

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Directions to “LOW T MENS CLINIC LP ” Practice Location

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