Provider Demographics
NPI:1871760421
Name:R G MEDICAL PLLC
Entity type:Organization
Organization Name:R G MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-687-1501
Mailing Address - Street 1:5001 BRENTWOOD STAIR RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-2801
Mailing Address - Country:US
Mailing Address - Phone:817-687-1501
Mailing Address - Fax:817-687-1500
Practice Address - Street 1:5001 BRENTWOOD STAIR RD
Practice Address - Street 2:SUITE 107
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2801
Practice Address - Country:US
Practice Address - Phone:817-687-1501
Practice Address - Fax:817-687-1500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSAL MEDICAL MANAGEMENT GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-13
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7045208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty