Unknown Individual – Adult Medicine Physician, NPI 1194863001
Adult Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
8504, Fairway Drive, Fort Worth, Tarrant County, Texas, 76179, United States
FORT WORTH, TX 761793121
Phone: (817) 236-8700
Fax: (817) 777-1956
Type: Mailing
Lockheed Martin, 1, Lockheed Boulevard, Fort Worth, Tarrant County, Texas, 76108, United States
FORT WORTH, TX 76108
Phone: (817) 777-6461
Fax: (817) 777-1956
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 76179)
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