Doctor Name: | DR. MARK RICHARD DAMBRO |
NPI Number: | 1528061009 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | H3998 |
Business Practice Address: | 2405 Stadium Dr Fort Worth, TX - 761091055 |
Business Phone Number: | 8172338781 |
Business Fax Number: | |
Mailing Address: | 2405 Stadium Dr, FORT WORTH |
State: | TX |
Postal Code: | 761091055 |
Phone Number: | 8172338781 |
Fax Number: | |
NPI Enumeration Date: | 05/27/2005 |
NPI Last Update Date: | 04/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | H3998 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |