Organization
2017 FWUC MEDICAL PROFESSIONALS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN BRAXTON NEIMAN (GENERAL COUNSEL)
(817) 421-0034
Entity
Organization
Contact information
Practice address
601 NORTHWEST PKWY STE C, AZLE, TX 76020-2930
(817) 270-0777
(817) 421-0036
Mailing address
920 S KIMBALL AVE, SOUTHLAKE, TX 76092-9016
(817) 527-3403
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/08/2017
Last updated
09/08/2017
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