Individual
CREED LEROY WAIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104
(817) 927-1395
(817) 927-3603
Mailing address
1617 HEMPHILL ST, FORT WORTH, TX 76104-4709
(817) 927-1395
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M4632
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162134001
—
AR
05
—
183776701
—
TX
05
—
200098880A
—
OK
Enumeration date
07/08/2006
Last updated
09/16/2015
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