Provider Demographics
NPI:1053502583
Name:WIDERHORN, JOSEF (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEF
Middle Name:
Last Name:WIDERHORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12229
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-8229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1307 8TH AVE STE 501
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4143
Practice Address - Country:US
Practice Address - Phone:817-922-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2843207R00000X, 207RC0000X, 207RC0001X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85K247OtherBLUE CROSS (HARRIS HOSP)
TX2837065-007OtherCIGNA PPO
TX2837065-012OtherCIGNA HMO
TXE51105OtherTRICARE (HARRIS HOSP)
TX2500101OtherUNITED HEALTHCARE
TX4236959OtherAETNA PPO
TX80420YOtherBLUE CROSS BLUE SHIELD
TX85K247OtherMEDICARE PIN (HARRIS HOSP
TX60055861OtherRAILROAD MEDICARE
TX2171076OtherATNA HMO
TX4236959OtherAETNA PPO
TX8C1765Medicare PIN