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Organization
LOW TESTOSTERONE MEN'S CLINIC FW, LLC
Active
Organization
LOW TESTOSTERONE MEN'S CLINIC FW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. IVONNE HERLINDA BRAXTON MS,FNP-BC (MANAGING MEMBER)
(817) 416-5698
Entity
Organization
Contact information
Practice address
6115 CAMP BOWIE BLVD STE 140, FORT WORTH, TX 76116-5500
(817) 416-5698
Mailing address
6115 CAMP BOWIE BLVD, SUITE 140, FORT WORTH, TX 76116-5512
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
07/09/2015
Last updated
06/16/2020
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