Organization
KETAMINE CLINIC OF NORTH TEXAS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALAN WAYNE CARRUTH MD (CO-OWNER)
(214) 929-9875
Entity
Organization
Contact information
Practice address
4100 FAIRWAY DR STE 200, CARROLLTON, TX 75010-6527
(214) 929-9875
Mailing address
4100 FAIRWAY DR STE 200, CARROLLTON, TX 75010-6527
(214) 929-9875
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
F9284
TX
Other
Enumeration date
10/04/2017
Last updated
10/04/2017
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