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Contact Information

FORT WORTH ENT,P.A.
1250 8TH AVE
SUITE 135
FORT WORTH, TX76104
 Phone: 817-335-8151
 Fax: 817-335-2670
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for FORT WORTH ENTPA · (Female)

NPI # 1336353366
Status Active
Credentials
Entity Individual
Enumeration date 05/09/2007
Last updated 01/24/2011 - About 15 years ago
Sole proprietor 1 Not specified
Identifiers
  • TX License # H2007
  • TX License # L4150
  • TX Medicaid 031074002
  • TX Medicaid 166927701
  • TX Other H2007 TODD E SAMUELSON MD LICEN
  • TX Other 8G2131 TODD E. SAMUELSON MD BCBS
Hospital affiliation(s) Not Available
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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