Provider Demographics
NPI:1659569556
Name:FORT WORTH FERTILITY
Entity Type:Organization
Organization Name:FORT WORTH FERTILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KAUFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-348-8145
Mailing Address - Street 1:1800 MISTLETOE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4062
Mailing Address - Country:US
Mailing Address - Phone:817-348-8145
Mailing Address - Fax:817-348-8264
Practice Address - Street 1:1800 MISTLETOE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4062
Practice Address - Country:US
Practice Address - Phone:817-348-8145
Practice Address - Fax:817-348-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0125174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty