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Organization
IBERIA MEDICAL CLINIC, P.A.
Active
Organization
IBERIA MEDICAL CLINIC, P.A.
Active
Other names
Southside Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA E THOMSON (CREDENTIALING MANAGER)
(817) 744-7524
Entity
Organization
Contact information
Practice address
546 W SEMINARY DR STE A, FORT WORTH, TX 76115-1361
(817) 924-7978
Mailing address
546 W SEMINARY DR STE A, FORT WORTH, TX 76115-1361
(817) 924-7978
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4172611-01
—
TX
05
—
4172611-02
—
TX
Enumeration date
04/02/2007
Last updated
04/09/2025
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