Individual
ENEDINA ENRIQUEZ ALCANTARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1300 W TERRELL AVE FL 2, FORT WORTH, TX 76104-2820
(817) 820-4906
(817) 820-4815
Mailing address
1300 W TERRELL AVE FL 2, FORT WORTH, TX 76104-2820
(817) 820-4906
(817) 820-4815
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
36397
IA
207R00000X
Internal Medicine Physician
036101575
IL
207R00000X
Internal Medicine Physician
Primary
M7817
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192733702
—
TX
Enumeration date
09/27/2005
Last updated
08/13/2012
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