MEDICARE: T OFF MEN'S HEALTH KELLER, LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1679016984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T OFF MEN'S HEALTH KELLER, LLC

Provider Business Mailing Address
First Line	:	8739 DAVIS BLVD
Second Line	:	A
City	:	KELLER
State	:	TX
Zip	:	76248-0309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8739 DAVIS BLVD
Second Line	:	A
City	:	KELLER
State	:	TX
Zip	:	76248-0309
Country	:	US
Telephone Number	:	817-889-7066
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXANDER HARPER
Credential	:
Telephone Number	:	817-889-7066

Provider Enumeration Date	:	11/18/2016
Last Update Date	:	11/18/2016

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