Provider Demographics
NPI:1558300137
Name:MODI, APURVA A (MD)
Entity Type:Individual
Prefix:
First Name:APURVA
Middle Name:A
Last Name:MODI
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 1:1250 8TH AVE
Mailing Address - Street 2:SUITE # 515
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4124
Mailing Address - Country:US
Mailing Address - Phone:817-922-9968
Mailing Address - Fax:817-922-9762
Practice Address - Street 1:1250 8TH AVE
Practice Address - Street 2:SUITE # 515
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4124
Practice Address - Country:US
Practice Address - Phone:817-922-9968
Practice Address - Fax:817-922-9762
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9912207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD007208700Medicaid
TX285797101Medicaid
I50867Medicare UPIN
TX285797101Medicaid
TXTXB137468Medicare PIN
TXP01087165Medicare PIN