Basic Information
| Provider Information | |||||||||
| NPI: | 1205838299 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENGLEKING | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100039 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761850039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175468212 | ||||||||
| FaxNumber: | 8175468215 | ||||||||
| Practice Location | |||||||||
| Address1: | 11801 SOUTH FWY | ||||||||
| Address2: | |||||||||
| City: | BURLESON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760287021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172939110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 06/12/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | F5195 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 099047502 | 05 | TX | MEDICAID |