Organization
PRO PHYSICIANS CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON D TRYGGESTAD (CEO)
(817) 886-8730
Entity
Organization
Contact information
Practice address
800 W MAGNOLIA AVE, FORT WORTH, TX 76104-4611
(817) 886-8730
(817) 866-8376
Mailing address
PO BOX 678234, DALLAS, TX 75267-8234
(817) 886-8730
(817) 866-8376
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A3258
MEDICARE PTAN
TX
Enumeration date
11/12/2008
Last updated
07/12/2013
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