Provider Demographics
NPI:1235180035
Name:FORT WORTH DIGESTIVE ASSOCIATES
Entity Type:Organization
Organization Name:FORT WORTH DIGESTIVE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-885-7888
Mailing Address - Street 1:PO BOX 470294
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76147-0294
Mailing Address - Country:US
Mailing Address - Phone:817-885-7888
Mailing Address - Fax:817-885-7811
Practice Address - Street 1:1650 W ROSEDALE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:817-885-7888
Practice Address - Fax:817-885-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0074MUOtherBCBS GROUP NUMBER
DD9949OtherMEDICARE RAILROAD
TX0074MUOtherBCBS GROUP NUMBER