MEDICARE: DR MOHAMMED CHAUDHRY

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	261QP2300X	Primary Care Clinic/Center	E2171	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

General Provider Information

NPI Number	:	1164685244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR MOHAMMED CHAUDHRY

Provider Business Mailing Address
First Line	:	4819 RIVER OAKS BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-3098
Country	:	US
Telephone Number	:	817-626-9744
Fax Number	:	817-626-9962

Provider Business Practice Location Address
First Line	:	4819 RIVER OAKS BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-3098
Country	:	US
Telephone Number	:	817-626-9744
Fax Number	:	817-626-9962

Authorized Official
Title or Position	:	MEDICAL BILLER
Name	:	JESSICA ANN LEDEZMA
Credential	:
Telephone Number	:	817-626-9744

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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Directions to “DR MOHAMMED CHAUDHRY ” Practice Location

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