Provider Demographics
NPI:1811067960
Name:GWEN A. FIELDS, M.D., P.A.
Entity type:Organization
Organization Name:GWEN A. FIELDS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-772-5400
Mailing Address - Street 1:PO BOX 678413
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8413
Mailing Address - Country:US
Mailing Address - Phone:972-772-5400
Mailing Address - Fax:972-722-7303
Practice Address - Street 1:2931 RIDGE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6670
Practice Address - Country:US
Practice Address - Phone:972-772-5400
Practice Address - Fax:972-722-7303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty