Provider Demographics
NPI:1235409558
Name:JOSEPH OBENG MD PA
Entity Type:Organization
Organization Name:JOSEPH OBENG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:YAW
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-875-3346
Mailing Address - Street 1:908 9TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3904
Mailing Address - Country:US
Mailing Address - Phone:817-870-1033
Mailing Address - Fax:817-870-1038
Practice Address - Street 1:908 9TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3904
Practice Address - Country:US
Practice Address - Phone:817-870-1033
Practice Address - Fax:817-870-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB148463Medicare PIN