Individual
DR. WYLIE TUCKER FOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0404
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
BP10063105
TX
2085R0202X
Diagnostic Radiology Physician
Primary
U8722
TX
208600000X
Surgery Physician
BP10063105
TX
Other
Enumeration date
05/08/2018
Last updated
06/05/2024
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