FORT WORTH ENT,P.A.
Medical Practice at 8 Ave, Fort Worth, TX

License number
Texas H2007
Category
Medical Practice
Type
Specialist
License number
Texas L4150
Category
Medical Practice
Type
Specialist
Owner
Name: MRS. VICKY L. VANVLECK
Title: PRACTICE MANAGER
Phone: (817) 335-8151
Address
Address
8Th Ave SUITE 135, Fort Worth, TX 76104
National Provider ID: 1336353366
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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FORT WORTH ENT, PA

Fort Worth, TX

Status:
Inactive
Industry:
Medical Doctor's Office
Doing business as:
Fort Worth Ent, PA<br>Todd E. Samuelson, M.D., PA
Registration:
Mar 18, 1994
Addresses:
1250 8 Ave STE 135, Fort Worth, TX 76104 (Mailing)
1001 12 Ave, Fort Worth, TX 76104
State ID:
0081509603
Business type:
Professional Association
Vice-Presidents:
Todd E. Samuelson President , Director , Member, inactive,J. Roy Lowry Director , Member , Vice-President, inactive,Jeremy P. Watkins President, Secretary, Director, Member, inactive,...
TIN:
32036021445

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