MEDICARE: TEXAS DIGESTIVE DISEASE CONSULTANTS, PLLC

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	333600000X	Pharmacy
2	3336S0011X	Specialty Pharmacy
3	3336C0003X	Community/Retail Pharmacy	31940	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2176985	OTHER		PK

General Provider Information

NPI Number	:	1053818344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS DIGESTIVE DISEASE CONSULTANTS, PLLC

Provider Business Mailing Address
First Line	:	1620 W NORTHWEST HIGHWAY
Second Line	:	SUITE 100
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-3119
Country	:	US
Telephone Number	:	817-572-0009
Fax Number	:	817-945-3778

Provider Business Practice Location Address
First Line	:	6317 HARRIS PKWY
Second Line	:	SUITE 320
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4256
Country	:	US
Telephone Number	:	682-707-3760
Fax Number	:	817-945-3778

Authorized Official
Title or Position	:	MANAGING OFFICER
Name	:	JAMES WEBER
Credential	:	M.D.
Telephone Number	:	682-707-3760

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	03/10/2025

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Directions to “TEXAS DIGESTIVE DISEASE CONSULTANTS, PLLC ” Practice Location

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