Individual
THEODORE SUNAO TAKATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 W TERRELL AVE, #500, FORT WORTH, TX 76104-2800
(817) 252-5000
(817) 252-5060
Mailing address
1300 W TERRELL AVE, #500, FORT WORTH, TX 76104-2800
(817) 252-5000
(817) 252-5060
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
K8508
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039267203
—
TX
05
—
039267205
—
TX
01
—
8M6142
BLUE CROSS
TX
01
—
P00226814
RAIL ROAD MEDICARE
TX
Enumeration date
10/10/2005
Last updated
08/15/2011
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