Organization
J. JOHN STASIKOWSKI, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACEK JOHN STASIKOWSKI M.D, P.A. (MEDICAL DOCTOR)
(817) 926-8002
Entity
Organization
Contact information
Practice address
1307 8TH AVE, SUITE 202, FORT WORTH, TX 76104-4137
(817) 926-8002
(817) 926-2315
Mailing address
1307 8TH AVE, SUITE 202, FORT WORTH, TX 76104-4137
(817) 926-8002
(817) 926-2315
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E5623
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031810701
—
TX
01
—
1619921392
NPI
TX
Enumeration date
12/29/2011
Last updated
12/29/2011
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