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Organization
RG MEDICAL
Active
Organization
RG MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY ODIWUOR (MANAGER)
(817) 413-8000
Entity
Organization
Contact information
Practice address
4716 E LANCASTER AVE, FORT WORTH, TX 76103-3836
(817) 413-8000
Mailing address
4716 E LANCASTER AVE, FORT WORTH, TX 76103-3836
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D6175
TX
Other
Enumeration date
04/09/2009
Last updated
05/19/2009
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