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NPI Code Detail

MEDICARE: MARY COURTENAY HAMBLEN DO

MEDICARE: MARY COURTENAY HAMBLEN DO
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 Physician2024-01212NC
2207RC0200XCritical Care Medicine (Internal Medicine) PhysicianU5708TX
3207P00000XEmergency Medicine PhysicianU5708TX
4390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1760069405
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY COURTENAY HAMBLEN DO
Provider Business Mailing Address
First Line : 200 W MAGNOLIA AVE STE 201
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-7657
Country : US
Telephone Number : 817-702-2799
Fax Number : 817-702-2140
Provider Business Practice Location Address
First Line : 1500 S MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4917
Country : US
Telephone Number : 817-702-2799
Fax Number : 817-702-2140
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2021
Last Update Date : 03/02/2026

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Directions to “ MARY COURTENAY HAMBLEN DO” Practice Location

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