Alliance Heritage Trace PLLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

L8824 Issued in TX

Legal business name

ALLIANCE HERITAGE TRACE PLLC

Doing business as

Alliance Pediatrics

Practice address

4400 Heritage Trace Pkwy
Suite 208
Fort Worth, TX 76244-8901

Phone

(817) 741-5437

Fax

(888) 400-5412

NPI assigned

Aug 23, 2012

Last updated

Oct 10, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Bruce David Martin, MDNPI 1043390974

Title

Owner

Phone

(817) 741-5437

Specialties & licenses 1

Addresses

Other names 1

• Alliance Pediatrics Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bruce D Martin, MD

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1043390974
  Authorized official Same address or phone

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

{
    "created_epoch": "1345680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349827200000",
    "number": "1689922627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12461 TIMBERLAND BLVD",
            "address_2": "SUITE 309",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762445213",
            "telephone_number": "817-741-5437",
            "fax_number": "888-400-5412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 HERITAGE TRACE PKWY",
            "address_2": "SUITE 208",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762448901",
            "telephone_number": "817-741-5437",
            "fax_number": "888-400-5412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE HERITAGE TRACE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-23",
        "last_updated": "2012-10-10",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-741-5437",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "L8824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alliance Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alliance Dental Care, PLLC
• Alliance Dental PLLC
• Alliance Diagnostic Imaging LLC
• Alliance Group Health, LLC
• Alliance Health & Wellness Center PLLC
• Alliance Kids Care
• Alliance Medical Weight Loss Clinic (Alliance Medical Spa)
• Alliance Network
• Alliance Ophthalmology, PLLC (Alliance Vision Institute)
• Alliance Oral & Maxillofacial Surgery, P.a. (Alliance Oral & Maxillofacial Surgery)

• Pediatrics Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; 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.