Provider Demographics
NPI:1629650791
Name:DOC D MEDICAL CONSULTING, PLLC
Entity Type:Organization
Organization Name:DOC D MEDICAL CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-484-6274
Mailing Address - Street 1:6913 CAMP BOWIE BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7164
Mailing Address - Country:US
Mailing Address - Phone:817-367-9289
Mailing Address - Fax:817-382-5217
Practice Address - Street 1:6913 CAMP BOWIE BLVD STE 107
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7164
Practice Address - Country:US
Practice Address - Phone:817-367-9289
Practice Address - Fax:817-382-5217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty