Individual
DR. MICHELLE MARTIN SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
800 8TH AVE STE 116, FORT WORTH, TX 76104-2606
(817) 335-6363
Mailing address
800 8TH AVE STE 116, FORT WORTH, TX 76104-2606
(817) 335-6363
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
5101020787
MI
208200000X
Plastic Surgery Physician
P4783
TX
2086S0122X
Plastic and Reconstructive Surgery Physician
5101020787
MI
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
P4783
TX
Other
Enumeration date
02/26/2013
Last updated
06/21/2023
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