Organization
MEDEVAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEWITT CHARLES FORTENBERRY MD (MEDICAL DIRECTOR)
(301) 641-5512
Entity
Organization
Contact information
Practice address
4920 ELIZABETH ST, TEXARKANA, TX 75503-2912
(903) 792-3812
Mailing address
116 WESTLAKE RD, TEXARKANA, TX 75501-0006
(903) 293-7093
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
L8691
TX
Other
Enumeration date
05/02/2012
Last updated
09/17/2023
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