MEDICARE: ALLERGY RELIEF OF TEXAS 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	207KA0200X	Allergy Physician	L2028	TX

General Provider Information

NPI Number	:	1093259293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY RELIEF OF TEXAS PLLC

Provider Business Mailing Address
First Line	:	7200 DUTCH BRANCH RD
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4143
Country	:	US
Telephone Number	:	817-346-7676
Fax Number	:	817-346-7779

Provider Business Practice Location Address
First Line	:	7200 DUTCH BRANCH RD
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4143
Country	:	US
Telephone Number	:	817-346-7676
Fax Number	:	817-346-7779

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES CAMERON THOMPSON
Credential	:	MD
Telephone Number	:	817-346-7676

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	12/07/2016

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