Provider Demographics
NPI:1093187205
Name:PAGE, SHEILA
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 COLLINSWORTH ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5739
Mailing Address - Country:US
Mailing Address - Phone:817-735-8741
Mailing Address - Fax:817-735-8836
Practice Address - Street 1:3221 COLLINSWORTH ST
Practice Address - Street 2:SUITE 160
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5739
Practice Address - Country:US
Practice Address - Phone:817-735-8741
Practice Address - Fax:817-735-8836
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine