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NPI Code Detail

MEDICARE: DR. RUTH REPOSA WILEY D.O.

MEDICARE: DR. RUTH REPOSA WILEY D.O.
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
1207V00000XObstetrics & Gynecology PhysicianM6462TX

General Provider Information

NPI Number : 1285810291
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUTH REPOSA WILEY D.O.
Provider Business Mailing Address
First Line : 851 WEST TERRELL AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3161
Country : US
Telephone Number : 817-926-4118
Fax Number :
Provider Business Practice Location Address
First Line : 851 W TERRELL AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3161
Country : US
Telephone Number : 817-926-4118
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2008
Last Update Date : 10/24/2008

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