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Organization
AZLE 611 ER PHYSICIANS PLLC
Active
Organization
AZLE 611 ER PHYSICIANS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN BRAXTON NEIMAN ESQ (GENERAL COUNSEL)
(817) 421-0034
Entity
Organization
Contact information
Practice address
611 NORTHWEST PARKWAY, AZLE, TX 76020-3654
(817) 421-0034
(817) 421-0036
Mailing address
PO BOX 93953, SOUTHLAKE, TX 76092-0119
(817) 421-0034
(817) 421-0036
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
—
NULL
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
—
—
Other
Enumeration date
02/01/2017
Last updated
02/01/2017
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