MEDICARE: DR. YARA HAMADE GONZALES 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	S7662	TX

General Provider Information

NPI Number	:	1609307115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YARA HAMADE GONZALES M.D.,

Provider Business Mailing Address
First Line	:	1500 S MAIN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4917
Country	:	US
Telephone Number	:	817-702-1173
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 BRYANT IRVIN RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3603
Country	:	US
Telephone Number	:	177-021-1008
Fax Number	:	817-569-9069

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

Provider Enumeration Date	:	03/26/2017
Last Update Date	:	08/27/2020

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