Individual
MR. ALEXANDER LEE PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
808 WOODROW WILSON RAY CIR, BRIDGEPORT, TX 76426-2061
(817) 966-2960
Mailing address
3250 RIVER LODGE TRL S APT 420, FORT WORTH, TX 76116-0830
(817) 966-2960
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1003207
TX
Other
Enumeration date
07/16/2020
Last updated
07/16/2020
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