Individual
DR. ALEX NELSON AUTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-3431
Mailing address
PO BOX 732973, DALLAS, TX 75391-2973
(817) 702-3431
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
51401
CO
207Q00000X
Family Medicine Physician
N9502
TX
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
51401
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11329777
—
CO
01
—
COA107696
MEDICARE PTAN
CO
Enumeration date
03/16/2009
Last updated
08/02/2022
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