MEDICARE: SHEILA PAGE

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	207Q00000X	Family Medicine Physician	J3707	TX

General Provider Information

NPI Number	:	1093187205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA PAGE

Provider Business Mailing Address
First Line	:	3221 COLLINSWORTH ST
Second Line	:	SUITE 160
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5739
Country	:	US
Telephone Number	:	817-735-8741
Fax Number	:	817-735-8836

Provider Business Practice Location Address
First Line	:	3221 COLLINSWORTH ST
Second Line	:	SUITE 160
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5739
Country	:	US
Telephone Number	:	817-735-8741
Fax Number	:	817-735-8836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2015
Last Update Date	:	10/27/2015

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Directions to “ SHEILA PAGE ” Practice Location

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