Basic Information
| Provider Information | |||||||||
| NPI: | 1326475344 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEUROPATHY PAIN CLINIC OF FORT WORTH | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DFW NEUROPATHY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3750 S UNIVERSITY DR | ||||||||
| Address2: | STE. 202 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761093795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179241000 | ||||||||
| FaxNumber: | 8179241001 | ||||||||
| Practice Location | |||||||||
| Address1: | 6210 CAMPBELL RD | ||||||||
| Address2: | STE. 225 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752481379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729313131 | ||||||||
| FaxNumber: | 9729313132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2013 | ||||||||
| LastUpdateDate: | 10/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | ALAVI | ||||||||
| AuthorizedOfficialFirstName: | ALI | ||||||||
| AuthorizedOfficialMiddleName: | HOSSEINI | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9729313131 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.