Organization
NORTH EAST TEXAS MID-LEVEL ASSIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY M KJELDGAARD D.O, (SOLE MEMBER)
(817) 283-5252
Entity
Organization
Contact information
Practice address
809 W HARWOOD RD STE 101, HURST, TX 76054-3293
(817) 283-5252
(817) 283-5283
Mailing address
809 W HARWOOD RD STE 101, HURST, TX 76054-3293
(817) 283-5252
(817) 283-5283
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA03242
TX
Other
Enumeration date
03/20/2015
Last updated
03/20/2015
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