Provider Demographics
NPI:1467488288
Name:ALFORD, BRENT T (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:T
Last Name:ALFORD
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 1:1900 MISTLETOE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4049
Mailing Address - Country:US
Mailing Address - Phone:817-878-5333
Mailing Address - Fax:817-878-5334
Practice Address - Street 1:1900 MISTLETOE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4049
Practice Address - Country:US
Practice Address - Phone:817-878-5333
Practice Address - Fax:817-878-5334
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1969207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H9675OtherBLUE CROSS BLUE SHIELD
TX143403702Medicaid
TX8D2856Medicare ID - Type Unspecified
TX143403702Medicaid