MEDICARE: PLAZA MEDICAL SPECIALISTS, 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1326379173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAZA MEDICAL SPECIALISTS, PLLC

Provider Business Mailing Address
First Line	:	301 CLIFFORD CENTER DR
Second Line	:	SUITE 115
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4443
Country	:	US
Telephone Number	:	817-737-6552
Fax Number	:	817-732-6597

Provider Business Practice Location Address
First Line	:	301 CLIFFORD CENTER DR
Second Line	:	SUITE 115
City	:	FORT WORTH
State	:	TX
Zip	:	76108-4443
Country	:	US
Telephone Number	:	817-737-6552
Fax Number	:	817-732-6597

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	TODD EVANS
Credential	:
Telephone Number	:	713-852-1550

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	01/19/2010

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