Individual
MARTIN A DERUSHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1506 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2027
(817) 882-0984
(817) 882-9978
Mailing address
1506 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2027
(817) 882-0984
(817) 882-9978
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
K0454
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H0101698
DPS
TX
Enumeration date
06/03/2006
Last updated
03/07/2023
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