Organization
FORTH WORTH SURGICAL ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM ROBERT PETTEY MD (OWNER)
(817) 370-9011
Entity
Organization
Contact information
Practice address
6100 HARRIS PKWY, #390, FORT WORTH, TX 76132-4128
(817) 370-9011
(817) 346-0380
Mailing address
6100 HARRIS PKWY, #390, FORT WORTH, TX 76132-4128
(817) 370-9011
(817) 346-0380
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G8340
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4254295
AETNA
—
01
—
91159
AMERIGROUP
—
Enumeration date
10/12/2005
Last updated
11/28/2007
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