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Organization

FORT WORTH PEDIATRICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DIANE RICHEY (ADMINISTRATOR)
(817) 336-4040
Entity
Organization

Contact information

Practice address
5708 EDWARDS RANCH ROAD, FORT WORTH, TX 76109
(817) 336-4040
(817) 336-6780
Mailing address
5708 EDWARDS RANCH ROAD, FORT WORTH, TX 76109
(817) 336-4040
(817) 336-6780

Taxonomy

Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
130900704
TX
Enumeration date
02/02/2010
Last updated
06/15/2011
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