Provider Demographics
NPI:1407894926
Name:ROHM, FRED W (DO)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:W
Last Name:ROHM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 OAKBEND TRL # 102
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3917
Mailing Address - Country:US
Mailing Address - Phone:817-294-4959
Mailing Address - Fax:817-294-1324
Practice Address - Street 1:6108 OAKBEND TRL # 102
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3917
Practice Address - Country:US
Practice Address - Phone:817-294-4959
Practice Address - Fax:817-294-1324
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF39109207Q00000X
TXJ1565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0029BKOtherBCBS
TX137380506Medicaid
TX930080887Medicare PIN
TX0029BKOtherBCBS
TX0029BKMedicare PIN