MEDICARE: FORT WORTH PERSONAL MEDICINE, 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	261QP2300X	Primary Care Clinic/Center	P9785	TX

General Provider Information

NPI Number	:	1609220367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT WORTH PERSONAL MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 181055
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76096-1055
Country	:	US
Telephone Number	:	682-202-4585
Fax Number	:

Provider Business Practice Location Address
First Line	:	4545 BELLAIRE DR S
Second Line	:	SUITE 2
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1889
Country	:	US
Telephone Number	:	682-202-4585
Fax Number	:

Authorized Official
Title or Position	:	CEO/PROVIDER
Name	:	DR. STEPHEN DANIEL AKE
Credential	:	D.O.
Telephone Number	:	682-202-4585

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	04/19/2016

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