Provider Demographics
NPI:1871758573
Name:DAVID N PODGURECKI, MD PA
Entity type:Organization
Organization Name:DAVID N PODGURECKI, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISER BILLER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:PODGURECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-561-4885
Mailing Address - Street 1:4110 FLOWER GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-3919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1670 E BROAD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1862
Practice Address - Country:US
Practice Address - Phone:817-473-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty