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NPI Code Detail

MEDICARE: AWET T GHEREZGHIHER M.D.

MEDICARE: AWET T GHEREZGHIHER 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
1208800000XUrology Physician52544AZ
2208800000XUrology PhysicianMT199237PA
3208800000XUrology PhysicianU8059TX

Other Identifiers

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

General Provider Information

NPI Number : 1871886622
Entity Type Code : Individual
Provider Name (Legal Business Name) : AWET T GHEREZGHIHER M.D.
Provider Business Mailing Address
First Line : 1300 W TERRELL AVE STE 400
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2829
Country : US
Telephone Number : 817-250-7247
Fax Number :
Provider Business Practice Location Address
First Line : 1300 W TERRELL AVE STE 400
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2829
Country : US
Telephone Number : 817-250-7247
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2011
Last Update Date : 02/08/2024

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