MEDICARE: JAMES L. ATTEBERRY III 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	207QA0505X	Adult Medicine Physician	F6400	TX

General Provider Information

NPI Number	:	1851754618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES L. ATTEBERRY III M.D.

Provider Business Mailing Address
First Line	:	101 RIVERCREST DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-1148
Country	:	US
Telephone Number	:	817-994-2671
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 RIVERCREST DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-1148
Country	:	US
Telephone Number	:	817-994-2671
Fax Number	:

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

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	03/30/2016

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