MEDICARE: MADISON BELLE THURMAN

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	363AM0700X	Medical Physician Assistant		TX
2	363AS0400X	Surgical Physician Assistant		TX

General Provider Information

NPI Number	:	1942156724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON BELLE THURMAN

Provider Business Mailing Address
First Line	:	800 8TH AVE STE 206
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2619
Country	:	US
Telephone Number	:	817-529-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 8TH AVE STE 206
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2619
Country	:	US
Telephone Number	:	817-529-9199
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ MADISON BELLE THURMAN ” Practice Location

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