Active NPI
John Licciardone, D.O.
- Neuromusculoskeletal Medicine & OMM Physician
- Fort Worth, TX
National Provider Identifier
1407829641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neuromusculoskeletal Medicine & OMM Physician
- License
- H3103
- Practice address
- Unthsc Patient Care Center
999 Montgomery
Fort Worth, TX 76107 - Phone
- (817) 735-2235
- Fax
- (817) 735-2480
- NPI assigned
- Feb 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuromusculoskeletal Medicine & OMM Physician | 204D00000X | H3103 | TX | Primary |
Addresses
Primary practice location
Unthsc Patient Care Center
999 Montgomery
Fort Worth, TX 76107
Mailing address
Unthsc Dept. of Quality Management
3500 Camp Bowie Blvd., Ead 324
Fort Worth, TX 76107
Phone (817) 735-0170
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H3103 | TX | MD | Neuromusculoskeletal Medicine & OMM Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204588800000",
"number": "1407829641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "UNTHSC DEPT. OF QUALITY MANAGEMENT",
"address_2": "3500 CAMP BOWIE BLVD., EAD 324",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "76107",
"telephone_number": "817-735-0170",
"fax_number": "817-735-0111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "UNTHSC PATIENT CARE CENTER",
"address_2": "999 MONTGOMERY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "76107",
"telephone_number": "817-735-2235",
"fax_number": "817-735-2480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICCIARDONE",
"first_name": "JOHN",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-08",
"last_updated": "2008-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "204D00000X",
"taxonomy_group": "",
"desc": "Neuromusculoskeletal Medicine & OMM",
"state": "TX",
"license": "H3103",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.