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NPI Code Detail

MEDICARE: ALLISON GANTER PA-C

MEDICARE: ALLISON GANTER PA-C
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
1363A00000XPhysician Assistant
2363AS0400XSurgical Physician Assistant

General Provider Information

NPI Number : 1568118644
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLISON GANTER PA-C
Provider Business Mailing Address
First Line : 5900 ALTAMESA BLVD STE 100
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-5475
Country : US
Telephone Number : 817-854-9969
Fax Number : 803-604-0854
Provider Business Practice Location Address
First Line : 5900 ALTAMESA BLVD STE 100
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-5473
Country : US
Telephone Number : 817-854-9969
Fax Number : 833-604-0854
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2022
Last Update Date : 03/18/2026

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Directions to “ ALLISON GANTER PA-C” Practice Location

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