Individual
ALAN L PODAWILTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2400
(817) 735-0615
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 735-2400
(817) 735-0615
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
K1900
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102041405
—
TX
01
—
8U1301
BCBS
TX
01
—
P00706279
RAILROAD MEDICARE
TX
Enumeration date
03/14/2006
Last updated
04/07/2016
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