Organization
AZLE 611 ER PHYSICIANS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN BRAXTON NEIMAN ESQ (GENERAL COUNSEL)
(817) 421-0034
Entity
Organization
Contact information
Practice address
611 NORTHWEST PARKWAY, AZLE, TX 76020-3654
(817) 421-0034
(817) 421-0036
Mailing address
PO BOX 93953, SOUTHLAKE, TX 76092-0119
(817) 421-0034
(817) 421-0036
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
—
—
Other
Enumeration date
02/01/2017
Last updated
02/01/2017
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