Organization
FORT WORTH FAMILY PRACTICE ASSOCIATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA ELLIS (OFFICE MANAGER)
(817) 244-4620
Entity
Organization
Contact information
Practice address
8030 CAMP BOWIE W, FORT WORTH, TX 76116-6313
(817) 244-4620
Mailing address
8030 CAMP BOWIE W, FORT WORTH, TX 76116-6313
(817) 244-4620
(817) 560-7159
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00436N
BCBS
TX
01
—
8440J0
BCBS
TX
Enumeration date
10/30/2007
Last updated
11/11/2009
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