Edge-MD Meadowbrook, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

N0318 Issued in TX

Legal business name

EDGE-MD MEADOWBROOK, PLLC

Practice address

6302 Meadowbrook Dr
Suite 112
Fort Worth, TX 76112-5162

Phone

(817) 446-0800

Fax

(817) 446-0802

NPI assigned

Nov 20, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nathan P. Nguyen, MD

Title

MD/Owner

Phone

(979) 532-2000

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421107200000",
    "number": "1134526007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2022 REGIONAL MEDICAL DR",
            "address_2": "SUITE 1315",
            "city": "WHARTON",
            "state": "TX",
            "postal_code": "774887231",
            "telephone_number": "979-532-2000",
            "fax_number": "979-532-2008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6302 MEADOWBROOK DR",
            "address_2": "SUITE 112",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761125162",
            "telephone_number": "817-446-0800",
            "fax_number": "817-446-0802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGE-MD MEADOWBROOK, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-20",
        "last_updated": "2015-01-13",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "979-532-2000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N0318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.