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NPI Code Detail

MEDICARE: APOLLO PHYSICIAN OF TEXAS PA

MEDICARE: APOLLO PHYSICIAN OF TEXAS PA
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
1207P00000XEmergency Medicine Physician
2363L00000XNurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10032MNOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1457300394
Entity Type Code : Organization
Provider Name (Legal Business Name) : APOLLO PHYSICIAN OF TEXAS PA
Provider Business Mailing Address
First Line : PO BOX 8730
Second Line :
City : FORT WORTH
State : TX
Zip : 76124-0730
Country : US
Telephone Number : 817-451-4208
Fax Number :
Provider Business Practice Location Address
First Line : 2555 JIMMY JOHNSON BLVD
Second Line :
City : PORT ARTHUR
State : TX
Zip : 77640-2007
Country : US
Telephone Number : 409-724-7389
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : ANTHONY KIRK WILLIAMS
Credential : MD
Telephone Number : 409-724-7389
Provider Enumeration Date : 05/09/2006
Last Update Date : 09/11/2025

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Directions to “APOLLO PHYSICIAN OF TEXAS PA ” Practice Location

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