Provider Demographics
NPI:1932176013
Name:DULEY, TROY M (PA C)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:M
Last Name:DULEY
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 HARRIS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4249
Mailing Address - Country:US
Mailing Address - Phone:817-433-3450
Mailing Address - Fax:817-294-6429
Practice Address - Street 1:6301 HARRIS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4249
Practice Address - Country:US
Practice Address - Phone:817-433-3450
Practice Address - Fax:817-294-6429
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04597363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB130015Medicaid
TX438467YKPWMedicare PIN
TXTXB130015Medicaid