MEDICARE: DR. DAN ALAN AXTHELM M.D.

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	207RR0500X	Rheumatology Physician	H3439	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	:	1417905225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAN ALAN AXTHELM M.D.

Provider Business Mailing Address
First Line	:	7100 OAKMONT BLVD
Second Line	:	STE 107
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3911
Country	:	US
Telephone Number	:	817-764-1894
Fax Number	:	817-346-7545

Provider Business Practice Location Address
First Line	:	7100 OAKMONT BLVD
Second Line	:	STE 107
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3911
Country	:	US
Telephone Number	:	817-764-1894
Fax Number	:	817-346-7545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	06/05/2018

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