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NPI Code Detail

MEDICARE: CTPC FORT WORTH, PLLC

MEDICARE: CTPC FORT WORTH, 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
1207L00000XAnesthesiology Physician
2208VP0000XPain Medicine Physician
3208VP0014XInterventional Pain Medicine Physician

General Provider Information

NPI Number : 1336514835
Entity Type Code : Organization
Provider Name (Legal Business Name) : CTPC FORT WORTH, PLLC
Provider Business Mailing Address
First Line : PO BOX 208357
Second Line :
City : DALLAS
State : TX
Zip : 75320-8354
Country : US
Telephone Number : 512-485-7208
Fax Number : 844-364-8678
Provider Business Practice Location Address
First Line : 7235 BOAT CLUB RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76179-4555
Country : US
Telephone Number : 817-573-9800
Fax Number : 817-573-9821
Authorized Official
Title or Position : MD/OWNER
Name : DANIEL FREDERICK
Credential : MD
Telephone Number : 512-485-7208
Provider Enumeration Date : 12/09/2015
Last Update Date : 09/11/2020

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Directions to “CTPC FORT WORTH, PLLC ” Practice Location

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