Provider Demographics
NPI:1255776605
Name:DE LA FUENTE, GUADALUPE JR (MD)
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:DE LA FUENTE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUPE
Other - Middle Name:
Other - Last Name:DE LA FUENTE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:800 5TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7303
Mailing Address - Country:US
Mailing Address - Phone:817-878-5300
Mailing Address - Fax:817-878-5321
Practice Address - Street 1:800 5TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7303
Practice Address - Country:US
Practice Address - Phone:817-878-5300
Practice Address - Fax:817-878-5321
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX574739207X00000X
TXS3150207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery