Provider Demographics
NPI:1710218169
Name:STRETCH, THERESA D (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:D
Last Name:STRETCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1806 W PLEASANT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4530
Mailing Address - Country:US
Mailing Address - Phone:817-635-6363
Mailing Address - Fax:817-635-6362
Practice Address - Street 1:1806 W PLEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4530
Practice Address - Country:US
Practice Address - Phone:817-635-6363
Practice Address - Fax:817-635-6362
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP20027635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CQ845OtherBCBS