Individual
DEREJE AYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11803 SOUTH FWY STE 311, BURLESON, TX 76028-7036
(817) 568-8411
(817) 568-8414
Mailing address
PO BOX 16284, FORT WORTH, TX 76162-0284
(817) 568-8411
(817) 568-8414
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
N0617
TX
207RP1001X
Pulmonary Disease Physician
Primary
N0617
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N0617
TEXAS LICENSE
TX
Enumeration date
01/23/2006
Last updated
10/08/2021
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