Provider Demographics
NPI:1972007748
Name:MEDICAL ASSOCIATES OF FORT WORTH PLLC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF FORT WORTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANWARULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-782-9020
Mailing Address - Street 1:412 MERCEDES ST STE G
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-2558
Mailing Address - Country:US
Mailing Address - Phone:817-782-9020
Mailing Address - Fax:
Practice Address - Street 1:412 MERCEDES ST STE G
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2558
Practice Address - Country:US
Practice Address - Phone:817-782-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty