Provider Demographics
NPI:1851754618
Name:ATTEBERRY, JAMES L III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:ATTEBERRY
Suffix:III
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 1:101 RIVERCREST DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-1148
Mailing Address - Country:US
Mailing Address - Phone:817-994-2671
Mailing Address - Fax:
Practice Address - Street 1:101 RIVERCREST DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-1148
Practice Address - Country:US
Practice Address - Phone:817-994-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6400207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine