Provider Demographics
NPI:1811055403
Name:HANBY, TAMARA K (DO)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:K
Last Name:HANBY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6302 A JACKSBORO HWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-3602
Mailing Address - Country:US
Mailing Address - Phone:817-237-8273
Mailing Address - Fax:817-237-0374
Practice Address - Street 1:6302 A JACKSBORO HWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3602
Practice Address - Country:US
Practice Address - Phone:817-237-8273
Practice Address - Fax:817-237-0374
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E18081Medicare UPIN
TX00B07PMedicare PIN