Individual
DR. JOHN LICCIARDONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
UNTHSC PATIENT CARE CENTER, 999 MONTGOMERY, FORT WORTH, TX 76107
(817) 735-2235
(817) 735-2480
Mailing address
UNTHSC DEPT. OF QUALITY MANAGEMENT, 3500 CAMP BOWIE BLVD., EAD 324, FORT WORTH, TX 76107
(817) 735-0170
(817) 735-0111
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
H3103
TX
Other
Enumeration date
02/08/2006
Last updated
03/04/2008
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