Organization
WEST SIDE ORTHOPAEDIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRON GLICKFELD DO (OWNER/PHYSICIAN)
(817) 738-6668
Entity
Organization
Contact information
Practice address
1002 MONTGOMERY ST, SUITE 107, FORT WORTH, TX 76107-2662
(817) 738-6668
Mailing address
1002 MONTGOMERY ST, SUITE 107, FORT WORTH, TX 76107-2662
(817) 738-6668
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0013HZ
GROUP BCBS
TX
01
—
CJ8419
GROUP MEDICARE RR
—
Enumeration date
05/18/2006
Last updated
10/24/2007
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