Provider Demographics
NPI:1447702964
Name:WEST FORT WORTH DERMATOLOGY, P.A.
Entity type:Organization
Organization Name:WEST FORT WORTH DERMATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:FURNISS
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-713-4301
Mailing Address - Street 1:4840 BRYANT IRVIN CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7679
Mailing Address - Country:US
Mailing Address - Phone:817-989-0300
Mailing Address - Fax:817-377-0970
Practice Address - Street 1:4840 BRYANT IRVIN CT
Practice Address - Street 2:SUITE 104
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7679
Practice Address - Country:US
Practice Address - Phone:817-989-0300
Practice Address - Fax:817-377-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7639207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty