Provider Demographics
NPI:1366497471
Name:AKWAR, FERGUS (MD)
Entity Type:Individual
Prefix:DR
First Name:FERGUS
Middle Name:
Last Name:AKWAR
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 1:3317 ALTAMESA BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-8746
Mailing Address - Country:US
Mailing Address - Phone:817-292-2011
Mailing Address - Fax:817-292-3691
Practice Address - Street 1:3317 ALTAMESA BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-8746
Practice Address - Country:US
Practice Address - Phone:817-292-2011
Practice Address - Fax:817-292-3691
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7638207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F5615Medicare PIN