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Organization

FORT WORTH DIAGNOSTIC CLINIC PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. PAUL JAY GOLDMAN M.D. (PHYSICIAN)
(817) 338-1131
Entity
Organization

Contact information

Practice address
1650 W ROSEDALE ST STE 100, FORT WORTH, TX 76104-7400
(817) 338-1131
(817) 877-1511
Mailing address
1650 W ROSEDALE ST STE 100, FORT WORTH, TX 76104-7400
(817) 338-1131
(817) 877-1511

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E8262
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
083588601
TX
Enumeration date
08/22/2007
Last updated
03/17/2015
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