Provider Demographics
NPI:1205130465
Name:MYMD HEALTH AND WELLNESS
Entity type:Organization
Organization Name:MYMD HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-701-0700
Mailing Address - Street 1:800 W ARBROOK BLVD
Mailing Address - Street 2:330
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4327
Mailing Address - Country:US
Mailing Address - Phone:817-701-0700
Mailing Address - Fax:817-417-8766
Practice Address - Street 1:800 W ARBROOK BLVD
Practice Address - Street 2:330
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4327
Practice Address - Country:US
Practice Address - Phone:817-701-0700
Practice Address - Fax:817-417-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5727207T00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty