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Individual

ALEXANDER P. VILAYTHONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
1650 W MAGNOLIA AVE, SUITE 207, FORT WORTH, TX 76104-4009
(817) 926-2544
Mailing address
1650 W MAGNOLIA AVE, SUITE 207, FORT WORTH, TX 76104-4009
(817) 912-8000

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N7760
TX
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
286104901
TX
05
286104902
TX
Enumeration date
06/11/2008
Last updated
02/14/2012
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