MEDICARE: JOAN L ABERNETHY MD

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	207W00000X	Ophthalmology Physician	K5322	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871590471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN L ABERNETHY MD

Provider Business Mailing Address
First Line	:	6551 HARRIS PKWY
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76132-6103
Country	:	US
Telephone Number	:	817-423-1800
Fax Number	:	817-510-0964

Provider Business Practice Location Address
First Line	:	6551 HARRIS PKWY
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76132-6103
Country	:	US
Telephone Number	:	817-423-1800
Fax Number	:	817-510-0964

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	05/31/2013

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Directions to “ JOAN L ABERNETHY MD” Practice Location

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