Organization
FT WORTH NEUROLOGY CONSULTANTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY A MOLENICH MD (OWNER)
(817) 920-0900
Entity
Organization
Contact information
Practice address
1307 8TH AVE, SUITE 301, FORT WORTH, TX 76104-4137
(817) 920-0900
(817) 920-0969
Mailing address
1307 8TH AVE, SUITE 301, FORT WORTH, TX 76104-4137
(817) 920-0900
(817) 920-0969
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00560X
BCBS
TX
05
—
084468001
—
TX
Enumeration date
09/12/2005
Last updated
07/12/2013
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