Individual
JANET LIETO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2660
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 735-2660
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
P1469
TX
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
P1469
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
284763401
—
TX
05
—
6401805
—
NJ
01
—
8CY268
BCBS
TX
01
—
P00998011
RAILROAD MEDICARE
TX
Enumeration date
05/01/2007
Last updated
07/13/2017
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