Provider Demographics
NPI:1417458068
Name:FORT WORTH PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:FORT WORTH PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MORVARID
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-243-7995
Mailing Address - Street 1:800 8TH AVE STE 626
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2605
Mailing Address - Country:US
Mailing Address - Phone:817-243-7995
Mailing Address - Fax:817-717-9494
Practice Address - Street 1:800 8TH AVE STE 626
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2605
Practice Address - Country:US
Practice Address - Phone:817-243-7995
Practice Address - Fax:844-573-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1765463Medicaid
TX1164692026OtherNPI