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Contact Information

MANJUSHREE GAUTAM, MD
1250 8TH AVE
SUITE 515
FORT WORTH, TX76104-4124
 Phone: 817-922-4675
 Fax: 817-922-4645
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Gastroenterology

207RG0100X 10 Physician/Gastroenterology
 

Hepatology

207RI0008X 11 Physician/Internal Medicine
 

Transplant Hepatology

207RT0003X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for MANJUSHREE GAUTAM · (Female)

NPI Number 1831172725
Status Active
Credentials MD
Entity Individual
Enumeration date 11/23/2005
Last updated 07/21/2015 - About 11 years ago
Sole proprietor 1 No
Identifiers
  • AZ License # 33778
  • TX License # N6309
  • AZ Medicaid 935554
  • TX Medicaid 217199301
  • AZ Other P00278312 RAILROAD MEDICARE
  • AZ Other 86080015085259D008 TRIWEST
  • TX Other 8BN847 BCBSTX
Hospital affiliation(s)
  • BAYLOR ALL SAINTS MEDICAL CENTER AT FW - (Acute Care)
    1400 EIGHTH AVE
    FORT WORTH, TX 76104
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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