Provider Demographics
NPI:1912260506
Name:ALLIANCE PRIMARY CARE ASSOC PLLC
Entity Type:Organization
Organization Name:ALLIANCE PRIMARY CARE ASSOC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-741-5437
Mailing Address - Street 1:12461 TIMBERLAND BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5213
Mailing Address - Country:US
Mailing Address - Phone:817-741-5437
Mailing Address - Fax:817-431-5870
Practice Address - Street 1:12461 TIMBERLAND BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5213
Practice Address - Country:US
Practice Address - Phone:817-741-5437
Practice Address - Fax:817-431-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8824208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty