Provider Demographics
NPI:1093998429
Name:DALLAS/FORT WORTH UROLOGY CONSULTANTS
Entity Type:Organization
Organization Name:DALLAS/FORT WORTH UROLOGY CONSULTANTS
Other - Org Name:DFW UROLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:HEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-731-0316
Mailing Address - Street 1:4809 BRENTWOOD STAIR ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103
Mailing Address - Country:US
Mailing Address - Phone:817-731-0316
Mailing Address - Fax:817-377-2081
Practice Address - Street 1:4809 BRENTWOOD STAIR ROAD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103
Practice Address - Country:US
Practice Address - Phone:817-731-0316
Practice Address - Fax:817-377-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty